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Medical Rehabilitation - quarterly journal
Volume 11 year 2007, Issue number 1
Medical Rehabilitation 2007; 11(1): 9-16
Assessment of the efficacy of rehabilitation with concomitant use of botulinum toxin in patients with cerebral palsy qualified for this therapy by means of objective gait analysis
Ocena skuteczności leczenia rehabilitacyjnego toksyną botulinową pacjentów z mózgowym porażeniem dziecięcym przy zastosowaniu obiektywnej analizy chodu do kwalifikacji pacjentów
Anna Święcicka, Małgorzata Syczewska
Department of Paediatric Rehabilitation, The Children's Memorial Health Institute, Warszawa, Poland
Received: 19.09.2006; accepted: 30.05.2007
Key words
cerebral palsy, botulinum toxin, gait analysis, treatment, rehabilitation
Abstract
Introduction: Botulinum toxin is more and more frequently used in rehabilitation treatment of CP patients, especially in children younger than 10 years. Its efficacy depends on several factors including proper qualification, planning of the treatment, and rehabilitation program following the injections. The aim of this paper was to evaluate the efficacy of rehabilitation treatment with botulinum toxin in CP patients using objective gait analysis as one of the qualification tools.
Material and Methods: Patients: 20 CP patients, aged from 2 to 15 years old. After the first assessment (passive ROM in joints, spasticity evaluation and assessment of motor development), patients underwent the objective gait analysis. The VICON 460 system synchronized with the 16-channel Motion Lab system for dynamic electromyography was used. Several trials were conducted and recorded in each patient (from 3 to 6). The following variables were recorded: spatio-temporal and kinematic parameters, as well as EMG of selected muscles. Based on clinical tests and results of objective gait analysis an individual treatment plan was established for each patient (dosage and sites for botulinum toxin injections). Clinical evaluation and gait analysis was repeated after 3 to 9 months. Patients underwent a rehabilitation program after the botulinum toxin injections.
Results: An improvement of gait pattern was found in all patients; there were no cases showing deterioration or no change. Both spatio-temporal and kinematic parameters were improved.
Conclusions: Botulinum toxin exerts its effects for 3 to 6 months; therefore, the second evaluation was performed after the direct effect disappeared. Appropriate planning, which takes into account results of the objective gait analysis, and the intensive rehabilitation program allow permanent improvement of gait pattern in CP children.