Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with cerebral palsy

Abstract

Clinicians use a range of clinical and objective measures to quantify the positive and negative features (impairments) of the upper motor neurone syndrome. These measures play an important role in the assessment and selection of suitable candidates for intervention and monitoring of outcome. Intervention strategies often focus on the positive features; however, outcome may be more contingent upon the severity of the negative features. The clinical protocol for patient selection and treatment used by our multidisciplinary team is presented, together with details of the assessment procedure. Measurement tools in routine use are described, including: the Modified Ashworth Scale, the Modified Tardieu Scale ('Rl'), muscle length by joint range of motion 'RZ', three-dimensional gait analysis, assessments of strength by the Medical Research Council Scale, Selective Motor Control, the Gross Motor Function Measure and the Observational Gait Scale. Three case studies of children with cerebral palsy who underwent botulinum toxin type A treatment as part of their management of gait disorder are presented, a 2-year-old girl with mild hemiplegia ('true equinus'), a 3-year-old boy with moderate hemiplegia ('apparent equinus') and a 6-year-old girl with diplegia, where a targeted approach was used to treat a distal problem and resulted in correction Of a proximal problem. Eur J Neurol 6 (suppl 4):S23-S35 0 Lippincott Williams & Wilkins

Do dynamic and static clinical measurements correlate with gait analysis parameters in children with cerebral palsy?

“…The tibio-femoral angle was measured according to Bleck [2] and Gage [7]. The Modified Ashworth Scale [9], the Modified Tardieu Scale [10], and the Duncan Ely test [2,7] were used to grade spasticity in the hip flexors and adductors, hamstrings, rectus femoris, gastrocnemius and tibialis posterior. Strength in the muscles was evaluated using manual muscle testing.…”

“…The scoring of strength in each muscle group was performed on a 10-point ordinal scale as described by Daniels and Worthingham [19]. Selectivity is the ability to move an individual joint independently from the other joints in the same limb and to use only the correct muscle groups during movement [7,10]. Selectivity was assessed in the hip extensors and abductors, knee extensors and flexors, and was scored using a five-point scale, proposed by Trost [21].…”

“…Selectivity was assessed in the hip extensors and abductors, knee extensors and flexors, and was scored using a five-point scale, proposed by Trost [21]. Selective motor control of the individual ankle dorsiflexors (with knee flexed and extended) was graded using a method based on Boyd and Graham [10].…”

“…Both gait analysis and clinical measurements are critical factors in the evaluation and treatment of gait disorders in children with CP. Clinical assessment includes the measurement of primary and secondary motor impairments such as range of motion (ROM) [5], spasticity [2,[8][9][10], muscle strength, selective motor control [2,10], pain [1], etc.…”

“…However, DeLuca et al [11] reported that computerized gait analysis information modified the surgical treatment recommendations made by experienced physicians for the patient with CP in about half (52%) of the patients evaluated. Gait analysis is usually combined with a clinical examination and studies often include both dynamic gait data and clinical assessment in order to report on the effect of several treatment methods [1,3,10]. However, scientific evidence on the benefits of three-dimensional gait analysis in addition to www.elsevier.com/locate/gaitpost Gait & Posture 24 (2006) [302][303][304][305][306][307][308][309][310][311][312][313] clinical examination is still insufficient.…”