Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy

Hoare, Brian; Wallen, Margaret; Imms, Christine; Villanueva, Elmer Virgil; Rawicki, Hyam Barry; Carey, Leeanne

doi:10.1002/14651858.cd003469.pub2

Cited by 64 publications

(15 citation statements)

References 112 publications

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“…In addition, multiple recent studies describe its successful use in the treatment of spasticity in individuals with cerebral palsy, stroke, head trauma, and multiple sclerosis. [17][18][19][20][21][22][23] Following direct injection of BoNT into an affected muscle, clinical benefit typically lasts 3 to 5 months. Depending on the size of the muscle, dosing ranges between 10 and 200 U.…”

Section: Phenol Blocksmentioning

confidence: 99%

Spastic Paralysis of the Elbow and Forearm

Gharbaoui

Kania

Cole

2016

Seminars in Plastic Surgery

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).Spasticity presents as muscular hypertonia and hyperexcitability of the stretch reflex, which are typical of upper motor neuron syndrome. 1,2 Physiopathologically, spasticity is due to the medullar and supramedullar alteration of the afferent and efferent pathways. Treatment is multidisciplinary and involves the collaboration of rehabilitators, neurophysiologists, neurologists, pediatricians, orthopaedic surgeons, and psychologists, who all contribute with their different therapeutic aspects and characteristics (which can be pharmacological, peripheral neurological blockages, surgical, etc.). 2,3 The characteristic posture of the upper extremities in spastic cerebral palsy is the inward rotation of the shoulder, flexion of the elbow and pronated forearm, flexion of the wrist with ulnar deviation, and the deformity of the fingers (flexion contracture, swan-neck, and thumbs-in-palm). [4][5][6] The primary objectives in these patients will be to improve communication with their surroundings, to perform activities of daily living, and to increase mobility and walking. Control of Spasticity Nonsurgical Management OptionsThe treatment of spasticity is highly dependent on the time since injury and the prognosis for recovery. In the period of neurologic recovery, temporizing interventions are most appropriate because permanent changes may result in the chronic imbalance of forces across joints. The prevention of additional complications, such as disuse muscle atrophy, joint contractures, heterotopic ossification, and peripheral neuropathies, is critical in optimizing functional outcome. 2,4,7 Several treatment choices are available, including cast and splint use, oral drug therapy, intrathecal baclofen, chemodenervation, neurolytic blocks, phenol blocks, and botulinum toxin (BoNT) blocks. 2,6,7 Cast and Splint UseIn addition to a variety of medical regimens to be discussed, various casting or splinting techniques can provide temporary relief of spasticity. Casting helps maintain muscle fiber length and diminishes muscle tone by decreasing sensory input and providing a structural impediment to spastic contracture. Changed on a weekly basis, serial casts can be used to correct joint contractures and is successful for contractures present < 6 months. Although there is some effect on spasticity, this is generally not a practical treatment modality. Dynamic splinting has a very limited role in treating spastic contractures and may even exacerbate the situation by triggering increased muscle tone. Both dynamic splints and serial casting may be very helpful after surgical release to correct the residual static component. As an adjunct, local anesthetic nerve blocks are helpful prior to cast application as they relieve spasticity and improve limb positioning. [6][7][8][9] Oral Drug Therapy Several oral antispastic agents may be used during this period; however, it is critical to understand the strengths Keywords ► spasticity ► hypertonia ► cerebral palsy ► nonsurgical treatment ► surgical treatment AbstractAs the physiologic ...

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Section: Phenol Blocksmentioning

confidence: 99%

Spastic Paralysis of the Elbow and Forearm

Gharbaoui

Kania

Cole

2016

Seminars in Plastic Surgery

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“…Conventional treatment of spasticity may include passive stretching [ 4 ], serial plastering and splints [ 5 ], pharmacologic treatment [ 6 ], and botulinum toxin [ 7 ]. From a theoretical point of view, shock waves could be useful to treat spasticity in patients with upper motor neuron syndrome.…”

Section: Introductionmentioning

confidence: 99%

Our experience with extracorporeal shockwave therapy (ESWT) in spastic children with cerebral palsy (CP)

Mirea¹,

Pădure²,

Spircu

et al. 2014

Annals of Physical and Rehabilitation Medicine

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Introduction. ESWT refers to the use of Shock Waves in medical practice. It was used as an important tool in spasticity management of children with CP. The aim of our study was to evaluate the effect of a 3 session of ESWT on spastic upper and lower limbs muscles in children with CP. Methods. Sixty-three children (37 boys and 26 girls), mean age 99.57±53.74 months, were included in the study. We used focused ESWT, applied in 3 sessions during the admission of each child, on the mainly affected muscles, using the same parameters on all patients (energy – 0.15 mJ/mm2, shot dose - 500 shocks/ session, frequency - 10 Hz). All patients were assessed two times: once, in admission (before any physical or ESWT appliance) and second, at discharge (after receiving the entire prescribed treatment), following: Modified Ashworth Scale (MAS), Gross Motor Function Classification System (GMFCS), Gross Motor Function Measure 66 (GMFM-66) and also a Questionnaire on Pain caused by spasticity (QPS).Results. We found a better and significant decrease of MAS level in the ESWT treated group, thus leading to a concomitant decrease of QPS score and also increase of GMFM-66 score.Conclusion. ESWT, applied in 3 sessions, with 0.15 mJ/ mm2, using 500 shocks/ min and 10 Hz as frequency may decrease children spasticity level and pain caused by it and improve the gross motor function.

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“…On the basis of these results, recent systematic reviews have concluded that there remains insufficient evidence for routine upper limb botulinum toxin A use, due to both a lack of large randomized controlled trials and limitations in functional outcome measures, such as the QUEST and the Melbourne Assessment of Unilateral Upper Limb Function [11,12]. Although the QUEST and the Melbourne Assessment have generally high test–retest reliability [13–15], they both rely on the observer making a subjective visual assessment of the child’s range and quality of upper limb movement, with the composite score possibly reducing the ability to detect change in a specific area [5,6].…”

Section: Introductionmentioning

confidence: 99%