Determinants of responsiveness to botulinum toxin, casting, and bracing in the treatment of spastic equinus in children with cerebral palsy
Article first published online: 15 JAN 2010
© The Authors. Journal compilation © Mac Keith Press 2010
Developmental Medicine & Child Neurology
Volume 52, Issue 2, pages 186–193, February 2010
How to Cite
YAP, R., MAJNEMER, A., BENAROCH, T. and CANTIN, M.-A. (2010), Determinants of responsiveness to botulinum toxin, casting, and bracing in the treatment of spastic equinus in children with cerebral palsy. Developmental Medicine & Child Neurology, 52: 186–193. doi: 10.1111/j.1469-8749.2009.03365.x
- Issue published online: 15 JAN 2010
- Article first published online: 15 JAN 2010
- PUBLICATION DATA Accepted for publication 15th March 2009.
Aim The objective was to determine whether specific intrinsic (age, pattern of cerebral palsy [CP], child’s motivation) and extrinsic (number of treatments, parenting stress) characteristics were associated with responsiveness to botulinum toxin A (BoNT-A) injections in children with CP 3 months after injection into the gastrocnemius muscle.
Method Children with hemiplegia or diplegia recruited from a BoNT-A programme were evaluated before and 3 months following injection of BoNT-A into the gastrocnemius. Outcome measures included muscle tone, range of motion, gait pattern, level of ambulation, gross motor function, and functional independence. Determinants of responsiveness to BoNT-A considered were age, number of treatments, distribution of CP, parenting stress, and motivation.
Results Thirty-one children were recruited (17 males, 14 females) – 22 with hemiplegia and nine with diplegia. Twenty-eight were classified at Gross Motor Function Classification System (GMFCS) level I and three at level III. The mean age was 6 years 4 months (SD 2y 11mo). Younger age (p=0.015) and fewer number (p=0.024) of BoNT-A treatments were associated with greater change in gross motor function. Child’s motivation and parenting stress were significantly associated with improvements in muscle tone (p=0.006–0.017), passive range of motion (p=0.008–0.033), gait pattern (p=0.005–0.042), level of ambulation (p=0.001–0.043), and functional independence (p=0.004–0.027).
Interpretation The results indicate that child, family, and treatment characteristics influence the degree of responsiveness to BoNT-A treatment. The contribution of contextual factors (personal and environmental) on responsiveness may be underappreciated in children with CP.