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Expert consensus on physical therapist intervention after botulinum toxin a injection for children with cerebral

H M Dumas1, M E O'neil, M A Fragala

  • 1The Research Center for Children with Special Health Care Needs and Physical Therapy Department, Franciscan Children’s Hospital and Rehabilitation Center (H.M.D., M.A.F.), Boston, Mass and Department of Rehabilitation Sciences, MCP Hahnemann University (M.E.O.), Philadelphia, Pa.

Pediatric Physical Therapy : the Official Publication of the Section on Pediatrics of the American Physical Therapy Association
|October 21, 2006
PubMed

Insights

Physical therapist experts reached consensus on key interventions for children with cerebral palsy (CP) receiving botulinum toxin A (BtA) injections. Functional ability significantly influences the choice of physical therapy interventions for lower extremity spasticity.

Area of Science:

  • Pediatric Physical Therapy
  • Neuromuscular Rehabilitation
  • Cerebral Palsy Management

Background:

  • Lower extremity spasticity in children with cerebral palsy (CP) often necessitates interventions like botulinum toxin A (BtA) injections.
  • Physical therapy (PT) plays a crucial role in optimizing outcomes post-BtA injection.
  • Understanding expert consensus on PT interventions is vital for evidence-based practice.

Purpose of the Study:

  • To establish expert consensus on physical therapist (PT) interventions following lower extremity botulinum toxin A (BtA) injections in children with CP.
  • To investigate how varying functional abilities in children with CP impact expert recommendations for PT interventions.

Main Methods:

  • A questionnaire based on the Guide to Physical Therapist Practice was developed.
  • Sixty-two pediatric physical therapy experts rated the importance of intervention components and direct interventions for two functional groups of children with CP.
  • Statistical analysis, including the Wilcoxon signed rank test and consensus criteria, was used to evaluate expert opinions.

Main Results:

  • Consensus was achieved for all three intervention components and four direct interventions (Therapeutic Exercise, Functional Training-Self-Care, Functional Training-Community and Work, Prescription of Devices/Equipment) for both functional groups.
  • Significant differences in the perceived importance of interventions were noted between the two functional groups, particularly for Patient/Client-Related Instruction and specific direct interventions.
  • Twenty intervention strategies met consensus criteria for at least one group.

Conclusions:

  • Key intervention components and specific direct interventions are consistently recognized as important in the PT plan of care post-BtA injection for pediatric lower extremity spasticity.
  • Children's functional ability is a significant factor influencing physical therapists' selection of interventions after BtA injections.
Abstract

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