Effect of Botulinum Toxin Type A on Functional Mobility in Cerebral Palsy with Lower Limb Spasticity
Introduction: Children with Cerebral Palsy (CP) often start walking much later than typically developing children and they do so with a slower speed and higher energy cost. Mobility varies across different environmental settings and Functional Mobility Scale (FMS) was devised to illustrate functiona...
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| Format: | Article |
| Language: | English |
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JCDR Research and Publications Private Limited
2018-05-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://jcdr.net/articles/PDF/11554/34639_CE[Ra]_F(Sh)_PF1(A_SL)_PFA(A_SHU_SL)_PN(SS).pdf |
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| author | Abhimanyu Vasudeva Nonica Laisram Asem Rangita Chanu |
| author_facet | Abhimanyu Vasudeva Nonica Laisram Asem Rangita Chanu |
| author_sort | Abhimanyu Vasudeva |
| collection | DOAJ |
| description | Introduction: Children with Cerebral Palsy (CP) often start walking much later than typically developing children and they do so with a slower speed and higher energy cost. Mobility varies across different environmental settings and Functional Mobility Scale (FMS) was devised to illustrate functional mobility in these children over three distinct distances, chosen to represent mobility in the home, at school and in the wider community. Botulinum toxin A injections into the gastrocnemius muscle for equinus foot deformity, as well as multilevel lower limb injections have shown improvements in gait, however, there is paucity of literature on its effect on functional mobility. Aim: To study the efficacy of Botulinum toxin A injection in CP with lower limb spasticity in terms of reduction in spasticity and effect on functional mobility. Materials and Methods: A total of 31 children were enrolled and evaluated for various outcome measures just before injection and at 4 and 12 weeks after injection. Change in FMS on follow-up was analysed using Wilcoxon signed-rank test. Spearman’s correlation analysis was performed between the number of injected muscles in each child and change in FMS scores on follow-up. A p-value of <0.05 was considered statistically significant. Analyses were done using SPSS version 21.0 statistical software (IBM Corp., Armonk, NY). Results: At distances of 5, 50 and 500 meters, FMS showed statistically significant improvement at four weeks (p-value <0.001 at 5; 0.002 at 50; 0.006 at 500 meters) and at 12 weeks (p-value <0.001 at 5; 0.001 at 50; 0.002 at 500 meters) compared with baseline but no significant change from 4 to 12 weeks (p-value=0.102 at 5; 1.000 at 50; 0.157 at 500 meters). There was moderate positive correlation between the number of injected muscles in each child and the change in FMS from baseline to 12 weeks at 5 meters distance; however, a moderate negative correlation was observed for the same at 500 meters. Conclusion: Local injection of Botulinum toxin A is effective in reducing the lower limb (gastrocnemius, hamstring, adductor) spasticity in CP children. It also improves the FMS in CP children. |
| first_indexed | 2024-12-18T14:44:49Z |
| format | Article |
| id | doaj.art-ac287ce30897490caf6269fd95a9a183 |
| institution | Directory Open Access Journal |
| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-12-18T14:44:49Z |
| publishDate | 2018-05-01 |
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| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-ac287ce30897490caf6269fd95a9a1832022-12-21T21:04:17ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2018-05-01125YC05YC0910.7860/JCDR/2018/34639.11554Effect of Botulinum Toxin Type A on Functional Mobility in Cerebral Palsy with Lower Limb SpasticityAbhimanyu Vasudeva0Nonica Laisram1Asem Rangita Chanu2Senior Resident, Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India.Consultant, Professor and Head, Department of Physical Medicine and Rehabilitation, Vardhman, Mahavir Medical College and Safdarjung Hospital, New Delhi, India.Assistant Professor, Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India.Introduction: Children with Cerebral Palsy (CP) often start walking much later than typically developing children and they do so with a slower speed and higher energy cost. Mobility varies across different environmental settings and Functional Mobility Scale (FMS) was devised to illustrate functional mobility in these children over three distinct distances, chosen to represent mobility in the home, at school and in the wider community. Botulinum toxin A injections into the gastrocnemius muscle for equinus foot deformity, as well as multilevel lower limb injections have shown improvements in gait, however, there is paucity of literature on its effect on functional mobility. Aim: To study the efficacy of Botulinum toxin A injection in CP with lower limb spasticity in terms of reduction in spasticity and effect on functional mobility. Materials and Methods: A total of 31 children were enrolled and evaluated for various outcome measures just before injection and at 4 and 12 weeks after injection. Change in FMS on follow-up was analysed using Wilcoxon signed-rank test. Spearman’s correlation analysis was performed between the number of injected muscles in each child and change in FMS scores on follow-up. A p-value of <0.05 was considered statistically significant. Analyses were done using SPSS version 21.0 statistical software (IBM Corp., Armonk, NY). Results: At distances of 5, 50 and 500 meters, FMS showed statistically significant improvement at four weeks (p-value <0.001 at 5; 0.002 at 50; 0.006 at 500 meters) and at 12 weeks (p-value <0.001 at 5; 0.001 at 50; 0.002 at 500 meters) compared with baseline but no significant change from 4 to 12 weeks (p-value=0.102 at 5; 1.000 at 50; 0.157 at 500 meters). There was moderate positive correlation between the number of injected muscles in each child and the change in FMS from baseline to 12 weeks at 5 meters distance; however, a moderate negative correlation was observed for the same at 500 meters. Conclusion: Local injection of Botulinum toxin A is effective in reducing the lower limb (gastrocnemius, hamstring, adductor) spasticity in CP children. It also improves the FMS in CP children.https://jcdr.net/articles/PDF/11554/34639_CE[Ra]_F(Sh)_PF1(A_SL)_PFA(A_SHU_SL)_PN(SS).pdfcerebral palsyfunctional mobility scalespasticity |
| spellingShingle | Abhimanyu Vasudeva Nonica Laisram Asem Rangita Chanu Effect of Botulinum Toxin Type A on Functional Mobility in Cerebral Palsy with Lower Limb Spasticity Journal of Clinical and Diagnostic Research cerebral palsy functional mobility scale spasticity |
| title | Effect of Botulinum Toxin Type A on Functional Mobility in Cerebral Palsy with Lower Limb Spasticity |
| title_full | Effect of Botulinum Toxin Type A on Functional Mobility in Cerebral Palsy with Lower Limb Spasticity |
| title_fullStr | Effect of Botulinum Toxin Type A on Functional Mobility in Cerebral Palsy with Lower Limb Spasticity |
| title_full_unstemmed | Effect of Botulinum Toxin Type A on Functional Mobility in Cerebral Palsy with Lower Limb Spasticity |
| title_short | Effect of Botulinum Toxin Type A on Functional Mobility in Cerebral Palsy with Lower Limb Spasticity |
| title_sort | effect of botulinum toxin type a on functional mobility in cerebral palsy with lower limb spasticity |
| topic | cerebral palsy functional mobility scale spasticity |
| url | https://jcdr.net/articles/PDF/11554/34639_CE[Ra]_F(Sh)_PF1(A_SL)_PFA(A_SHU_SL)_PN(SS).pdf |
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