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Published on: March 28, 2018
Use of three-dimensional kinematic analysis following upper limb botulinum toxin A for children with hemiplegia
A H Mackey1, F Miller, S E Walt
1Department of Surgery, University of Auckland, Auckland, New Zealand. a.mackey@auckland.ac.nz
Insights
Three-dimensional (3-D) kinematic analysis detected subtle upper limb improvements in children with hemiplegia after botulinum toxin A injections, showing potential as an objective clinical trial outcome measure.
Area of Science:
- Pediatric rehabilitation
- Neuroscience
- Biomechanical analysis
Background:
- Children with hemiplegia often experience upper limb functional limitations.
- Botulinum toxin A injections are used to reduce spasticity in affected muscles.
- Assessing treatment efficacy requires sensitive outcome measures.
Purpose of the Study:
- To evaluate the utility of 3-D kinematic analysis in detecting functional changes.
- To assess upper limb task performance in children with hemiplegia post-botulinum toxin A.
- To determine if 3-D kinematics can serve as an objective outcome measure.
Main Methods:
- Ten children with hemiplegic cerebral palsy underwent botulinum toxin A injections and occupational therapy.
- 3-D kinematic analysis was performed on reach and hand-to-mouth tasks.
- Measures included active range of motion, modified Ashworth scores at baseline and 2, 6, 12 weeks post-injection.
Main Results:
- Elbow flexor muscle tone reduction was observed for 12 weeks (p < 0.05).
- Group-level kinematic changes in active range of motion were not significant.
- Individual analysis revealed improvements in elbow extension and forearm supination in some participants at 2 weeks.
Conclusions:
- 3-D kinematic analysis can identify subtle changes in active movements post-botulinum toxin A.
- This technique shows promise as an objective outcome measure for clinical trials in pediatric hemiplegia.
- Individualized kinematic assessments may reveal treatment effects not apparent in group analyses.
Background And Purpose:
To examine whether three-dimensional (3-D) kinematic analysis can detect changes in upper limb tasks (reach and hand-to-mouth) in children with hemiplegia, following upper limb botulinum toxin A injections.
Methods:
Ten children with hemiplegic cerebral palsy (7 males, 3 females, aged 9-17 years). Subjects received botulinum toxin A (Botox) injections into elbow forearm muscles combined with 6 weeks of occupational therapy. Participants completed a 3-D kinematic analysis of two upper limb tasks, Melbourne Assessment of Unilateral Upper Limb Function and modified Ashworth scores measured at baseline, 2, 6 and 12 weeks post-injection.
Results:
Post-injections, elbow flexor muscle tone was reduced for 12 weeks (p < 0.05). Group differences in active range of motion during 3-D analysis tasks could not be demonstrated at any time post-intervention. However, individual analyses found that at 2 weeks post-injection, three subjects had >15 degrees increases in active elbow extension and six subjects showed an increase of >25 degrees in forearm supination during performance of the reach and hand-to-mouth tasks, respectively.
Conclusions:
3-D kinematics can detect changes in active movements during functional tasks following botulinum toxin A injections, suggesting this could be a potential objective outcome measure in a clinical trial.
