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Published on: August 9, 2024
Evaluation of a multimodal management of prematurity-related spasticity
Antigone S Papavasiliou1, Christina-Anastasia Rapidi, Constantine Filiopoulos
1Department of Neurology, Pendeli Children's Hospital, Athens, Greece. theon@otenet.gr
Insights
Botulinum toxin A injections improved lower limb spasticity and range of motion in children with cerebral palsy, leading to functional gains and high parent satisfaction. Some children even improved their Gross Motor Function Classification System level.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Orthopedics
Background:
- Cerebral palsy (CP) is a common neurodevelopmental disorder affecting motor function.
- Spasticity in the lower limbs is a significant challenge in children with CP, impacting mobility and function.
- Botulinum toxin A injections are a key intervention for managing spasticity.
Purpose of the Study:
- To evaluate the efficacy of a rehabilitation protocol using botulinum toxin A for lower limb spasticity in prematurely born children with CP.
- To assess improvements in range of motion, motor function, functional goals, and Gross Motor Function Classification System (GMFCS) levels.
- To determine long-term outcomes and parental satisfaction with the treatment.
Main Methods:
- A prospective study of 57 prematurely born children with CP, categorized by GMFCS levels.
- Intervention involved botulinum toxin A injections for lower limb spasticity.
- Outcome measures included goniometry, Gross Motor Function Measure (GMFM), functional goal attainment, GMFCS status, and parent satisfaction.
- Follow-up extended beyond 18 months.
Main Results:
- Significant improvements in lower limb range of motion (popliteal angles) were observed at 10 days, 1 month, and persisted beyond 18 months post-injection (P < 0.001).
- The Gross Motor Function Measure (GMFM) showed significant improvement in 20 children at 3 months (P < 0.0001).
- Functional goals were achieved by 61% of participants, with approximately 90% parental satisfaction.
- 31.57% of children improved their GMFCS level, with the most substantial gains in the severely affected GMFCS IV group.
Conclusions:
- Botulinum toxin A combined with rehabilitation effectively manages lower limb spasticity in prematurely born children with CP.
- The treatment leads to significant improvements in range of motion and functional mobility.
- Improvements in GMFCS levels, particularly in severely affected children, highlight the importance of spasticity management for achieving functional gains like sitting balance.
Abstract:
To examine the efficacy of a rehabilitation protocol, focusing on spasticity management through botulinum toxin A injections in the lower limbs, an etiologically homogeneous group of 57 prematurely born children with cerebral palsy was prospectively evaluated (minimum follow-up 18 months) under pragmatic conditions. Gross Motor Function Classification System categories were: I = 12, II = 9, III = 16, IV = 15, V = 4. Outcome was evaluated with goniometry, Gross Motor Function Measure, functional goal attainment at baseline and in subsequent months, the Gross Motor Function Classification System, functional mobility status, and parents' satisfaction at more than 18 months after first botulinum toxin. Goniometry demonstrated significantly improved range of movement in lower limbs at 10 days and 1 month after botulinum toxin. Differences persisted >18 months at the popliteal angles (P < 0.001). Gross Motor Function Measure changed significantly in 20 children (8 points in total score) at 3 months after first botulinum toxin (P < 0.0001) with less significant results thereafter. Predetermined functional goals were achieved in 61% at >18 months. Parents were satisfied in approximately 90% of the cases. Eighteen of 57 children (31.57%) changed Gross Motor Function Classification System status over a mean of 33.8 months (18-48) follow-up. Most significant gains were recorded in the severely involved group IV, where 10 of 15 (66.66%) improved. The high percentage of change in group IV implies the importance of gained sitting balance due to spasticity management.
