Sonoelastographic Evaluation of Medial Gastrocnemius Muscles Intrinsic Stiffness After Rehabilitation Therapy With Botulinum Toxin A Injection in Spastic Cerebral Palsy

Park, Gi-Young; Kwon, Dong Rak

doi:10.1016/j.apmr.2012.06.024

Cited by 60 publications

(39 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the literature, there are some suggestions that toxin injection into spastic muscle may be helpful to muscle growth in length and thereby can prevent the development of joint contracture and deformity 33. A recent report demonstrated reduction of muscle stiffness after injection in these children upon sonoelastographic evaluation 2. From this perspective, early management of spasticity with BoNT-A injection in children with spastic CP seems to be helpful to muscle growth for length and stiffness.…”

Section: Discussionmentioning

confidence: 99%

“…As well, spasticity can also lead to significant structural alterations in muscles 1. Therefore, many therapeutic interventions, including physical modalities, anti-spastic drugs and orthoses, have been employed in an attempt to reduce spasticity 2. Injection of botulinum toxin type A (BoNT-A) into spastic muscles is widely used as a safe and effective intervention for pediatric spastic management.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Architectural Changes of the Gastrocnemius Muscle after Botulinum Toxin Type A Injection in Children with Cerebral Palsy

et al. 2014

View full text Add to dashboard Cite

PurposeThis study used ultrasonography (US) to investigate the architectural changes in gastrocnemius muscles (GCM) after botulinum toxin injection (BoNT-A) in children with cerebral palsy (CP).Materials and MethodsThirteen children with CP who received a BoNT-A injection into their GCM to treat equinus were recruited (9 males and 4 females). Architectural changes in both the medial and lateral heads of the GCM from a total of 20 legs were assessed using B-mode, real-time US. Muscle thickness (MT), fascicle length (FL), and fascicle angle (FA) were measured over the middle of the muscle belly in both a resting and neutral ankle position. Measures at 1 and 3 months after the injection were compared with baseline data taken before the injection.ResultsThe mean age of the subjects was 5.8 (±1.6) years. Spasticity was significantly reduced when measured by both the modified Tardieu scale and the modified Ashworth scale at 1 and 3 months after injection (p<0.05). The MT and FA of both the medial and lateral heads of the GCM were significantly reduced for both neutral and resting ankle positions at 1 and 3 months after the injection. The FL of both the medial and lateral heads of the GCM were significantly increased in a resting position (p<0.05), but not in a neutral position.ConclusionOur results demonstrated muscle architectural changes induced by BoNT-A injection. The functional significances of these changes were discussed.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Architectural Changes of the Gastrocnemius Muscle after Botulinum Toxin Type A Injection in Children with Cerebral Palsy

et al. 2014

View full text Add to dashboard Cite

show abstract

“…In another study conducted on children with spastic diparetic CP with the same design, it was reported that intrinsic stiffness of muscles decreased at the end of 4 weeks [77]. Some authors discussed that spastic muscle relaxation facilitates extremity growth and decreases fixed contracture development [57,77,78].…”

Section: Changes Occurring In the Intrinsic Structure Of Muscle With mentioning

confidence: 99%

“…Motor unit and reflex activity formed against muscle length growth is indicated as the neural foundation, and mental status, stress, fatigue, decreased sarcomere number and decreased flexibility, muscle stiffness and high collagen content in spastic muscle are indicated as the nonneural components [76,77].…”

Section: Changes Occurring In the Intrinsic Structure Of Muscle With mentioning

confidence: 99%

How Does Botulinum Toxin Injection and Physiotherapy Complement Each Other in Cerebral Palsy?

Akbaş¹

2016

Botulinum Toxin Therapy Manual for Dystonia and Spasticity

View full text Add to dashboard Cite

Cerebral Palsy (CP) is a clinical condition that describes impairments of motor and sensory systems due to a lesion in immature brain. CP-related disorders effect movements, balance and posture of the child. Spasticity is most frequent motor disorder seen in CP and effects 70-80% of the children with CP. Spasticity can lead to abnormalities in all motor system levels involving muscles, joints, bones and tendons. If spasticity exists for long period of time, immobilization of muscles in short position and changes in the connective tissue around joints lead to shortening of the muscles and connective tissue. Various methods are used for spasticity management in children with CP. Botulinum neurotoxin (BoNT) injections, oral medications, selective dorsal rhizotomy and intrathecal baclofen applications are the foremost among them. BoNT injections are most prevalently used one among these applications. BoNT, which is a neurotoxin obtained from Clostridium botulinum bacteria, is frequently used in children with CP to decrease muscle tone for a certain period in the selected muscles, prevent contractures, postpone surgery and decrease frequency of surgeries. During this time frame that muscle tone decreased, it is very important to increase activity and participation levels of children. For achieving better motor outcomes and functional independence, BoNT injections should be combined with physiotherapy (PT) and occupational therapy (OT).

show abstract

“…The increased collagen content in the spastic muscle is indirectly estimated using RTS, since RTS measures intrinsic muscle stiffness. In children with spastic CP, changes in intrinsic muscle stiffness after BTA injection have been documented using RTS [11,12]. Intrinsic muscle stiffness increases with age-related rise of non-reducible collagen content in spastic muscle [13].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Treatment Effects Between Children With Spastic Cerebral Palsy Under and Over Five Years After Botulinum Toxin Type A Injection

2014

Self Cite

View full text Add to dashboard Cite

ObjectiveTo evaluate whether age influences a change in the spasticity of the ankle plantar flexor after botulinum toxin type A (BTA) injection in children with spastic cerebral palsy (CP).MethodsSixteen children with spastic CP were enrolled in the study. Seven children (group 1) were under 5 years of age, and nine (group 2) were over 5 years of age. They all received BTA injection in the gastrocnemius muscle (GCM) under ultrasound guidance. Passive range of motion (PROM) of ankle dorsiflexion, Modified Ashworth Scale (MAS) of the ankle plantar flexor, Gross Motor Function Measure (GMFM) and median red pixel intensity (RPI) of the medial GCM on real-time sonoelastography were measured at baseline (pre-injection) and 1-, 3-, and 6-month post-injection.ResultsIn both groups, the mean PROM, MAS, and RPI were significantly improved after injection until 6-month post-injection. The change of PROM of ankle dorsiflexion in group 1 was significantly greater than that in group 2, until 6-month post-injection. The change in the MAS and GMFM between baseline and 6-month post-injection in group 1 was greater than that in group 2. The changes in the median RPI between baseline and 3- and 6-month post-injections were greater in group 1 than in group 2.ConclusionOur pilot study demonstrated the different changes in spasticity of the ankle plantar flexor after BTA injection based on age. Therefore, age may be considered when establishing a treatment plan using BTA injection for children with spastic CP.

show abstract

Sonoelastographic Evaluation of Medial Gastrocnemius Muscles Intrinsic Stiffness After Rehabilitation Therapy With Botulinum Toxin A Injection in Spastic Cerebral Palsy

Cited by 60 publications

References 15 publications

Architectural Changes of the Gastrocnemius Muscle after Botulinum Toxin Type A Injection in Children with Cerebral Palsy

Architectural Changes of the Gastrocnemius Muscle after Botulinum Toxin Type A Injection in Children with Cerebral Palsy

How Does Botulinum Toxin Injection and Physiotherapy Complement Each Other in Cerebral Palsy?

Comparison of Treatment Effects Between Children With Spastic Cerebral Palsy Under and Over Five Years After Botulinum Toxin Type A Injection

Contact Info

Product

Resources

About