Determinants of responsiveness to botulinum toxin, casting, and bracing in the treatment of spastic equinus in children with cerebral palsy

Authors

  • RITA YAP,

    1. Shriners Hospitals for Children, Montreal, Quebec, Canada
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  • ANNETTE MAJNEMER,

    1. Departments of Neurology & Neurosurgery, and Pediatrics, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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  • THIERRY BENAROCH,

    1. Department of Surgery, Division of Orthopaedic Surgery, Montreal Children’s Hospital, Shriners Hospitals for Children, McGill University, Montreal, Quebec, Canada
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  • MARIE-ANDREE CANTIN

    1. Department of Surgery, Division of Orthopaedic Surgery, Ste-Justine’s Hospital, Shriners Hospitals for Children, Université de Montreal, Montreal, Quebec, Canada.
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Rita Yap at Shriners Hospitals for Children, 1529 Cedar Avenue, Montreal, Quebec, Canada, H3G 1A6. E-mail: ryap@shrinenet.org

Abstract

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.

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