Outcomes of Botulinum Toxin Type A Injection Followed by Rehabilitation in Cases of Cerebral Palsy With Upper Extremity Involvement

Abstract

We evaluated the efficiency of botulinum toxin type A injection followed by a rehabilitation program including individual therapy, group therapy, and occupational therapy in cases of cerebral palsy with upper extremity involvement. A total of 29 injections were performed on 25 patients, and the patients were placed on rehabilitation program. At 3-month and 6-month assessments, there was a significant improvement in lateral grip strength, 9 Hole Peg test, Upper Limb Physician's Rating Scale and pediatric functional independence measure total scores. There were significant decreases in active range of motion in elbow extension, supination, and wrist extension, and Modified Ashworth Scale in elbow flexion, elbow pronation, and wrist flexion at 6-week, 3-month, and 6-month assessments. Combination of group therapy with traditional therapy methods after injection is effective in cases of cerebral palsy with upper extremity involvement.

Binocular low-contrast letter acuity and the symbol digit modalities test improve the ability of the Multiple Sclerosis Functional Composite to predict disease in pediatric multiple sclerosis

“…Mean completion time and standard deviation varies with age (decreasing times to complete the task with increasing age), sex (faster times in females), and hand dominance (slower times for the nondominant hand). The 9HPT is recommended as part of the NIH toolbox for assessment of neurologic and behavioral function for children and adults and has been used to assess therapeutic interventions in other neurologic diseases in children such as Friedreich’s ataxia, Charcot-Marie Tooth disease, and cerebral palsy(Lynch et al 2006; Pareyson et al 2006; Estilow et al 2012; Mannil et al 2014; Karaca et al 2015). Of note, adult MS patients with worsening on the 9HPT also experienced change in fatigue, mood, sexual function, and lower limb function, in addition to arm function, suggesting that the 9HPT may capture impairment in more global domains than just upper extremity function(Kragt et al 2006).…”

Clinical differences between A1 and A2 botulinum toxin subtypes

“…As demonstrated by Koizumi and colleagues 15 , cSNAP25 is found not only in the spinal motor neurons but also the neuropils in contact with these neurons. It is likely that intramuscularly injected botulinum toxin can affect not only the neuromuscular junction but also the synapses in contact with motoneurons, thus reversing the abnormal synaptic plasticity, and facilitating the contacts of the indirect descending pathways from the brain developed by intensive rehabilitation after the injection18 .Clinical trial of A1LL and A2NTX for post-stroke lower limb spasticity Post-stroke spasticity is a major socio-economical as well as medical problem in countries with accelerated aging such as Japan, Korea, and China 19 . For instance, bent-knee is a form of spasticity that makes the stroke survivor incapacitated.…”

A consensus statement on the use of botulinum toxin in pediatric patients

“…There is sufficient evidence to demonstrate that the use of BoNT in the upper limbs can improve functional outcomes when combined with therapy. 221,[223][224][225][226][227][228][229][230][231][232][233][234] However studies were too varied in their duration and frequency of therapy to provide appropriate guidance.…”