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Quantitative effects on proximal joints of botulinum toxin treatment for gastrocnemius spasticity: a 4-year-old case
Veronica Cimolin1, Manuela Galli, Marcello Crivellini
1Bioengineering Department, Politecnico di Milano, Piaza Leonardo da Vinci 32, 20133 Milano, Italy.
Insights
Botulinum toxin A injections improved gait in a child with cerebral palsy. While initial hip function temporarily declined, long-term analysis showed significant improvements in ankle, knee, and hip joint movement and power.
Area of Science:
- Neurology
- Pediatrics
- Biomechanical Engineering
Background:
- Cerebral Palsy (CP) often involves spasticity, impacting motor function.
- Botulinum Toxin A (BTA) is used for early spasticity management in children with CP.
- Gait Analysis (GA) is crucial for evaluating motor impairments.
Observation:
- This study analyzed the gait pattern of a 4-year-old child with diplegic CP and calf contracture.
- Data were collected before, 5 days after, and 3 months after BTA injections into the gastrocnemius muscle.
- Kinematic and kinetic data of lower limb joints were meticulously examined.
Findings:
- Short-term (5 days) BTA treatment improved ankle dorsi-plantarflexion and knee flex-extension but caused compensatory hip flexion.
- Long-term (3 months) BTA treatment demonstrated generalized improvements in hip and knee range of motion.
- Significant enhancements in ankle kinematics, kinetics, and propulsive capacity were observed at 3 months post-injection.
Implications:
- BTA injections can lead to positive long-term gait modifications in children with CP.
- Dynamic changes in joint compensation patterns warrant further investigation.
- Optimizing BTA treatment protocols may enhance functional mobility and quality of life in pediatric CP patients.
Abstract:
Botulinum toxin A (BTA) is a recognized treatment for the early management of spasticity in children with Cerebral Palsy. This study quantified with Gait Analysis (GA) the gait pattern of a 4-year-old diplegic child with calf contracture before, 5 days, and 3 months after BTA injections into gastrocnemius. Kinematic and kinetic data of main lower limb joints were investigated. After only 5 days, ankle dorsi-plantarflexion and knee flex-extension improved, but hip joint worsened, increasing its excessive flexion, to compensate the improvement in knee position of the treated limb and to obtain better stability. A worsening of hip power happened. After 3 months, all joints generally improved their position during gait cycle. Hip and knee joints increased their range of movement and improvements occurred at ankle kinematics and kinetisc, too; a better ankle position and an increase of its capacity of propulsion during terminal stance were evident.
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