Botulinum toxin A and physical therapy in gait in cerebral palsy
Main Article Content
Keywords
Botulinum toxins, type A, Cerebral palsy, Gait disorders, neurologic, Central nervous system diseases
Abstract
Background: Cerebral palsy (PCI) is the leading cause of disability in children. Botulinum toxin type A (TBA) is a treatment to improve the function and pattern in the gait, although with a few studies that quantify the improvement
Methods: Quasi-experimental study was conducted from May 2010 to September 2011, in Integrated Rehabilitation Center, in 36 patients with spastic PCI. Was evaluated: functionality of travel by the scale of Koman, speed of the gait with tone scale of Ashworth and arches of passive mobility, were applied TBA and was sent to 10 sessions of physical therapy, with measurements taken before, the 1st and 4th month.
Results: 30 Patients completed the study, between the ages of 2 and 12 years, the majority had improvement in the functionality of the gear, tone, dorsiflexion and abduction of ankles to the motion, which was maintained at 4 months.
Conclusions: Botulinum toxin is an effective treatment to increase the arches of mobility and functionality of the gait of patients with hemiparesis and spastic paraparesis.
References
Himmelmann K, Hagberg G, Beckung E, Hagberg B, Uvebrant P. The changing panorama of cerebral palsy in Sweden. Prevalence and origin in the birth-year period 1995-1998. Acta Paediatr. 2005;94(3):287-94.
Florian H, Desloovere K, Schroeder S. The updated European Consensus 2009 on the use of botulinum toxin for children with cerebral palsy. European journal of paediatric neurology. 2009;30:1-22.
García-Benítez C, Venta-Sobero JA, Hernández-Sánchez J, Navarro-Vargas JL. Consenso mexicano para la aplicación de toxina botulínica en padecimientos neurológicos. Revista Mexicana de Neurociencia. 2009;10(2):107-111.
Camargo CH, Hélio AG. Botulinum toxin type a in the treatment of lower-limb spasticity in children with cerebral palsy. Arq Neuropsiquiatr. 2009;67(1):62-68.
Scholtes V, Dallmeijer A. The combined effect of lower-limb multilevel botulinum toxin type A and comprehensive rehabilitation on mobility in children with cerebral palsy: A randomized clinical trial. Arch Phys Med Rehabil. 2006;87(12):s70-77.
Vivancos-Matellano F, Pascual-Pascual SI, Nardi-Vilardaga J, Miquel-Rodríguez F, de Miguel-León I, Martínez-Garre MC et al. Guía del tratamiento Integral de la espasticidad. Rev Neurol. 2007;45(6):365-375.
Pascual-Pascual SI. Guía terapéutica de la espasticidad infantil con toxina botulínica. Rev Neurol. 2007;44(5):303-309.
Johnson DC, Damiano DL, Abel MF. The evolution of gait in childhood and adolescent cerebral palsy. J Pediatri Orthop. 1997;17:392-6.
Shapiro BK. Cerebral palsy: A reconceptualization of the spectrum. J Pediatr. 2004;145(Suppl 2):S3-7.
Cosgrove AP, Graham HK. Botulinum toxin A prevents the development of contractures in hereditary spastic muscle. Dev Med Child Neurol. 1994;36:379-85.
Aguilar-Barberá M, Calopa-Garriga M, Sánchez-Dalmau B. Indicaciones actuales del tratamiento con toxina botulínica. Rev Neurol. 1997;25:138-270.
Garreta-Figuera R, Chaler-Vilaseca J, Torrequebrada-Giménez A. Guía de práctica clínica del tratamiento de la espasticidad con toxina botulínica. Rev Neurol. 2010;50(11):685-699.
Agencia de Evaluación de Tecnologías e Investigación Médicas de Cataluña. Guía de practica clínica del ictus. 2a ed. Barcelona: AATRM; 2007.
Gage JR, Schwartz M. Pathological gait and lever-arm dysfunction. London:Mac Keith Press; 2004. 80-204.
Merello M. Fisiopatología, Clínica, y Tratamiento de la espasticidad, Rev Sección Movimientos Anormales, Instituto de Investigaciones Neurologicas Raúl Carrea –FLENI- Buenos Aires Argentina, Vol 7, num 2, 34-37
Forsberg H, Tedroff K. Botulin toxin treatment in cerebral palsy: Intervention with poor evaluation? Dev Med Chil Neurol. 1997:39:635-40.
Pascual-Pascual SI. Tratamiento preventivo y paliativo con toxina botulínica de la cadera en el niño con parálisis cerebral infantil. Rev Neurol. 2003;37:80-2.
Carew T. Posture and locomotion. Principles of neural sciences. New York; Elsevier: 1996.
Koman LA, Mooncy JF, Smith BP, Walker F. Botulinum toxin type A neuromuscular blocked in the treatment of lower extremity in cerebral palsy: A randomized, double-blind, placebo controlled trial. J Pediatr Orthop. 2000;20;108-115.
Hazneci B, Tan AK, Guncikan MN. Comparison of the efficacy of botulinum toxin A and Johnstone pressure splints against hip adductor spasticity among patients with cerebral palsy, a randomized trial. Mil Med. 2006;171:653-656.
Hense S, Brandl-Hesse B, Seide U. Lower limb muscle activity in ambulatory children with cerebral palsy before and after the treatment with Botulinum toxin A. Restor Neurol Neurosci. 2000;17(1):1-8
Reddihough DD, King JA, Coleman GJ et al. Functional outcome of botulinum toxin A injections to the lower limbs in cerebral palsy. Dev Med Child Neurol. 2002;44;820-27.
Reddihough D, Bach T, Burgess G, Oke L, Hudson I. Comparison of subjetive and objetive measures of movements performance of children with cerebral palsy. Dev Med Child Neurol. 1991;33:578-84.
Sutherland DH, Kaufman KR, Wyatt MP, Chambers HG. Injection of botulinum A toxin into the gastrocnemius muscle of patients with cerebral palsy: A 3-dimensional motion analysis study. Gait Posture. 1996;4:269-279.
Boyda RN, Haysb RM. Current evidence for the use of botulinum toxin type A in the management of children with cerebral palsy: A systematic review. European Journal of Neurology. 2001;8(Suppl 5):1-20.