PILOT STUDY ON OUTCOME MEASURES IN TREATMENT OF ADOLESCENTS WITH CEREBRAL PALSY WITH BOTULINUM TOXIN.
Anthony B Ward (Keele University, Stoke on Trent, UK)
Botulinum toxin has been shown to be of benefit for spasticity in cerebral palsy. Among the problems of adult cerebral palsy are deformities of hip and knee flexion, adduction and rotation of the lower limb, tight calf muscles and tendo achilles and toe clawing resulting in foot pronation and instability of the weight bearing. The standard outcome measures for botulinum toxin treatment in acquired disorders are frequently irrelevant, reflecting the different aetiology. Young people with cerebral palsy have invariably adapted to carrying out activities of daily living and do not have considerable pain or frequent spasms. We assessed the outcomes of six cerebral palsy patients with spastic diplegia, aged between 16-21 years, in a pilot study following standard doses of botulinum toxin injections for localised spasticity. Four had his adductor problems and two had lower leg problems. They were followed up with regular physiotherapy and assessed at monthly intervals for four months. Assessments included joint range of movement, spastcity on the modified Ashworth scale, walking speed, stride length, VAS scores for pain, Barthel ADL scale and a five point subjective change. Those with hip adductor problems improved to a greater extent than those with lower leg problems and the measurements that appear most promising and correlate greatest with patient satisfaction in walking are decrease in hip fixed flexion deformity and improvements in walking speed (using a 10m walking time) and stride length, which were better than reduction in hip adductor spasticity. Pain and ADL scores were of little value for this group of patients and the findings from this pilot are worthy of further study.
GAIT ANALYSIS OF CEREBRAL PALSY AFTER SELECTIVE POSTERIOR RHIZOTOMY
Tae-Sun Kim, Chang-Il Park, Ji-Cheol Shin, You-Chul Kim, Seong-Woo Kim, (Yonsei University College of Medicine, Seoul, Korea)
Purpose: To evaluate the effects of selective posterior rhizotomy (SPR) on range of motion, strength, spasticity and gait parameters in spastic cerebral palsy (CP) children.
Method: Ambulatory children with spastic CP whose ages varied from 3.3 to 7.3 years were included in this study. They were evaluated preoperatively and 2 - 4 months after SPR. The joint ROM, strength, manual test of spasticity, and gait analysis using Vicon 370 M. A. System were done.
Result: The strength of hip muscles was reduced, and knee muscles slightly increased. Ankle dorsiflexors and plantarflexors did not change significantly. Spasticity decreased after SPR. Kinematic data showed significant increases in maximum ankle dorsiflexion in stance and swing phases. Ankle position at initial contact phase changed from -10.5°to 2.9° dorsiflexion after SPR. Cadence, walking velocity, and step length were slightly decreased without significance after SPR.
Conclusion: SPR is an effective treatment method to reduce spasticity and to improve gait pattern in spastic CP children.