Combining strength training and botulinum neurotoxin intervention in children with cerebral palsy: the impact on muscle morphology and strength. (April 2013)

• Record Type: Journal Article
• Authors: Williams, Sîan A.; Elliott, Catherine; Valentine, Jane; Gubbay, Anna; Shipman, Peter; Reid, Siobhan
• Is Part Of: Disability and rehabilitation. Volume 35:Number 7(2013:Apr.)
• Page Start: 596
• Page End: 605
• Publication Date: 2013-04
• Subjects: People with disabilities -- Periodicals; Rehabilitation -- Periodicals; 617.03
• DOI: 10.3109/09638288.2012.711898
• Languages: English
• ISSNs: 0963-8288

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <p> <italic>Purpose:</italic> Investigate the combination effects of strength training and Botulinum Toxin Type-A (BoNT-A) on muscle strength and morphology in children with Cerebral Palsy (CP). <italic>Methods:</italic> Fifteen children receiving BoNT-A, classified as Spastic Diplegic CP, GMFCS I-II, and aged 5–12 years were recruited for this study. Randomly allocated to 10 weeks of strength training either before or after BoNT-A, children were assessed over 6 months. Eight of the 15 children also completed a control period. The Modified Ashworth Scale measured spasticity. The Goal Attainment Scale (GAS) assessed achievement of functional goals. Magnetic Resonance Imaging assessed muscle volume (MV). Instrumented dynamometry assessed strength. <italic>Results:</italic> Spasticity was significantly reduced following BoNT-A injection (p = 0.033). Children made significant isokinetic strength gains (mean p = 0.022, ES = 0.57) in the intervention period compared to the control period (mean p = 0.15, ES = 0.56). Irrespective of timing, significant strength improvements were seen immediately (10 weeks) and over 6 months for all children. This was also the case for improvements in the GAS (immediately: mean p = 0.007, ES = 4.17, 6 months: mean p = 0.029, ES = 0.99), and improvements in MV in all assessed muscles. <italic>Conclusion</italic>: The simultaneous use of BoNT-A and strength training was successful in spasticity reduction, improving strength and achieving functional goals, over and above treatment with BoNT-A alone. Muscles targeted for BoNT-A injection should be included in strength training.</p> </abstract>