34 Use of the modified tardieu scale in treatment planning for lower limb botulinum toxin-a injections in ambulant children with cerebral palsy. (23rd February 2023)

• Record Type: Journal Article
• Authors: Katchburian, Lesley; Hodgson, Xanthe; Crowe, Belinda; Carr, Lucinda; Wray, Jo; Main, Eleanor
• Is Part Of: Archives of disease in childhood. Volume 108(2023)Supplement 1
• Page Start: A13
• Page End: A13
• Publication Date: 2023-02-23
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2023-gosh.34
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Background: Hypertonia is a primary motor impairment in children-and-young-people with cerebral palsy (CYPwCP) and significantly contributes to secondary musculoskeletal impairment impacting on activity and participation. Botulinum Toxin-A (BoNT-A) is used for the management of spasticity (hypertonia) in CYPwCP, and clinically assessed with the Modified-Tardieu-Scale (MTS) at slow (R2) and fast velocity (R1). R2-R1 reflects the 'dynamic component'. It is suggested that the greater the dynamic component, the more amenable muscles are to treatment with BoNT-A. This prospective single site study, evaluated the ability of MTS to predict response of BoNT-A treatment in CYPwCP. Methods: Dynamic spasticity was assessed in 64 CYPwCP using the MTS at baseline, 6 weeks, 6 months, and 12 months following BoNT-A. Injected muscles, gastrocnemius (52 children) and hamstrings (25 children), were categorised as responders or non-responders, depending on the change of R1 from baseline with reference to reported standard errors of measurement of ≥5° in gastrocnemius and ≥10° in hamstrings. Results: The baseline dynamic range (MTS R2-R1) was found to be predictive for the odds of a positive response to BoNT-A in gastrocnemius muscles, at all post-injection time-points (ORs 1.12-1.15, p<.001, CI 1.05, 1.24), with a larger dynamic component associated with greater odds of improvement. The reverse was true for hamstring muscles although baseline dynamic range was also a significant predictor of outcome, a smaller baseline dynamic component was associated with greater odds of improvement at all time points. Conclusion: The dynamic component of MTS (R2-R1) was a fair predictor of response to BoNT-A treatment for gastrocnemius muscles. Interestingly, the reverse was true for hamstring muscles within this study. Further research is required to evaluate the predictive ability of MTS to assist in the selection of patients for BoNT-A treatment. The inclusion of additional outcome measures would enhance the evaluation of the efficacy of BoNT-A treatment.