Effects of early spasticity treatment on children with hemiplegic cerebral palsy: a preliminary study

Abstract

Objective: To compare motor and functional performance of two groups of children with hemiplegic cerebral palsy (HCP). Only the study group (SG) received early treatment of spasticity with botulinum neurotoxin type A (BXT-A). Methods: Gross Motor Function Measure (GMFM), functional performance (Pediatric Evaluation of Disability Inventory -PEDI), range of movement, gait pattern (Physician Rating Scale -PRS) and the speed of hand movements were considered. Results: The SG, composed of 11 HCP (45.64±6.3 months), was assessed in relation to the comparison group, composed of 13 HCP (45.92±6.4 months). SG showed higher scores in four of the five GMFM dimensions, which included scores that were statistically significant for dimension B, and higher scores in five of the six areas evaluated in the PEDI. Active wrist extension, the speed of hand movements and PRS score were higher in the SG. Conclusion: Children who received early BXT-A treatment for spasticity showed higher scores in motor and functional performance.Key words: child, botulinum toxins, type A, cerebral palsy, hemiplegia. RESUMOObjetivo: Comparar a performance motora e funcional de dois grupos de crianças com paralisia cerebral hemiplégica (PCH). Apenas o grupo de estudo (GE) recebeu tratamento precoce da espasticidade com toxina botulínica do tipo A (BXT-A). Métodos: Foram considerados a Função Motora Grossa (Gross Motor Function Measure -GMFM), performance funcional (Pediatric Evaluation of Disability Inventory -PEDI), amplitude de movimento, padrão da marcha (Physician Rating Scale -PRS) e a velocidade de movimento das mãos. Resultados: O GE, composto de 11 PCH (45,64±6,3 meses), foi analisado em relação ao grupo de comparação, composto por 13 PCH (45,92±6,4 meses). O GE mostrou maiores escores em quatro das cinco dimensões da GMFM, sendo a diferença estatisticamente significativa na dimensão B, e melhores escores em cinco das seis áreas avaliadas na PEDI. A extensão ativa do punho, a velocidade de movimento das mãos e o escore na PRS foram maiores no GE. Conclusão: As crianças que receberam tratamento precoce da espasticidade com BXT-A mostraram melhores escores motores e funcionais.Palavras-Chave: criança, toxinas botulínicas tipo A, paralisia cerebral, hemiplegia.The ultimate goal for the treatment of children with cerebral palsy (CP) is an improvement in functionality and increased independence, which will prepare these children for adult life 1 . The prognosis of a child with CP often depends on the type and severity of the palsy and the accompanying medical comorbidities 2 . In hemiplegic cerebral palsy (HCP), different severities and combinations of impairments in sensory function, perception, muscle tone, muscle strength and range of motion contribute to their motor dysfunction. Furthermore, these factors should be evaluated and managed because functionality is a component of overall health, and the appropriate combinations of interventions can improve function 3 .

Age Specificity in General and Rehabilitation Medical Services in Children With Cerebral Palsy

“…Although it is imperative to start the CP treatment at the earliest possible time, great attention must also be put on a specific treatment process in relation to particular age. Delay in initiating treatment and lack of systematic method in accordance with age may result in secondary problems, such as joint contracture, muscle shortening, and deformity, which in turn reduce treatment efficacy and impede functional improvement that could otherwise be enhanced with a proper treatment strategy [ 10 , 15 , 16 ].…”

Influence of adapted hip-hop dancing on quality of life and social participation among children/adolescents with cerebral palsy

“…Studies have shown that physical/motor aspects such as flexibility, coordination, and balance in young individuals with CP benefit from dance practice and are important to prevent inactivity leading to loss of strength, endurance, and mobility in these individuals 11,12 . While dancers seek to optimize their performances, the vast repertoire of styles and body techniques that comprise hip-hop 24 serve as a motivation, which is recognized as key to neuroplasticity 25 while stimulating motor learning 26 .…”

“…This demands from the dancer body awareness and trunk mobility 24 , preventing complications and deterioration of his or her health status 27 . Rhythmic alternation suggests that movements are executed repetitively, which benefits motor learning and reduces spasticity 26 . The movements of the trunk and lower and upper limbs can be trained separately to be executed simultaneously and continuously, in a coordinated way and synchronized with the rhythm 24 .…”

“…• Mobility: The training promotes dissociation of the pelvic and scapular waists, which is necessary to reduce fixed postures caused as a result of spasticity 26 . The movements carried out on the floor stimulate the weight transfer to hands and feet for body support 24 , necessary for appropriate bone development, neuromuscular stimulation, and muscle strengthening, as well as to reduce neglect of the affected limbs 26 . Recommended shoes for this dance are sneakers with flat soles, which enable orthosis during the activity.…”

Early Fesoterodine Fumarate Administration Prevents Neurogenic Detrusor Overactivity in a Spinal Cord Transected Rat Model

“…Some studies clearly support preventive strategies to avoid, delay or reduce the emergence of several pathological conditions associated with neurological diseases, such as chronic pain or spasticity [3–5]. Similarly, after acute supra-sacral SCI, early pudendal nerve stimulation (PNS) and sacral neuromodulation (SNM) have been reported to successfully obviate DO, enhancing the potential of preventive measures against SCI-related DO [6,7].…”