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Neurorehabilitation with versus without resistance training after botulinum toxin treatment in children with cerebral
Thomas Bandholm1, Bente R Jensen, Lone M Nielsen
1Gait Analysis Laboratory, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark. Thomas.Bandholm@hvh.regionh.dk
Insights
Progressive resistance training (PRT) combined with botulinum toxin type A (BoNT) improved maximal plantarflexion torque in children with cerebral palsy (CP). Both PRT and conventional therapy enhanced ankle dorsiflexion control.
Area of Science:
- Pediatric Rehabilitation
- Neuromuscular Disorders
- Biomedical Engineering
Background:
- Botulinum toxin type A (BoNT) injections are used to treat spasticity in children with cerebral palsy (CP).
- Physical rehabilitation is often prescribed alongside BoNT to maximize functional gains.
- The specific role of progressive resistance training (PRT) in conjunction with BoNT for CP requires further elucidation.
Purpose of the Study:
- To compare the efficacy of physical rehabilitation with (PRT) versus without (CON) progressive resistance training following botulinum toxin type A (BoNT) treatment in children with CP.
- To assess the impact of PRT and CON on ankle muscle function, gait, balance, gross motor function, and spasticity.
Main Methods:
- Fourteen children with CP received supervised PRT or CON twice weekly for 12 weeks post-BoNT treatment.
- Outcome measures included ankle muscle function (torque, steadiness, EMG), 3D gait analysis, sway analysis, GMFM-66, and modified Ashworth spasticity scale.
- Measurements were taken at baseline, and 4 and 12 weeks post-BoNT injection.
Main Results:
- Submaximal dorsiflexion torque steadiness improved similarly in both PRT and CON groups, correlating with reduced soleus co-activity.
- Maximal plantarflexion torque increased significantly following PRT, whereas it decreased in the CON group.
- No significant changes in overall gait, balance, or gross motor function were observed in either group.
Conclusions:
- Both PRT and CON, when combined with BoNT, equally enhance antagonist ankle dorsiflexion torque control through reduced co-activity.
- Only PRT demonstrated an increase in maximal plantarflexion torque, suggesting a potential benefit for specific muscle strength outcomes.
- Further research is needed to explore the long-term functional implications of PRT in pediatric CP rehabilitation.
Objective:
To compare the effects of physical rehabilitation with (PRT) and without (CON) progressive resistance training following treatment of spastic plantarflexors with botulinum toxin type A (BoNT) in children with cerebral palsy (CP).
Methods:
Fourteen children with CP performed supervised PRT (n=7) or CON (n=7) two times per week for 12 weeks, following the BoNT-treatment. Outcome measurements were performed at baseline (pre BoNT), and 4 and 12 weeks post BoNT. They consisted of: ankle muscle function (maximal torque and submaximal torque steadiness of isometric ankle dorsi- and plantarflexion and associated ankle muscle [EMG] activity), gait function (3-dimensional gait analysis), balance function (sway analysis), gross motor function (GMFM-66), and spasticity (modified Ashworth).
Results:
Submaximal torque control (torque steadiness) of isometric dorsiflexion improved similarly in the two groups, and the improvement was related to the reduction in antagonist (soleus) co-activity (P< 0.05). Maximal plantarflexion torque increased after PRT, whereas a reduction was seen after CON (P< 0.05). No changes in function were observed.
Conclusions:
Both types of physical rehabilitation in combination with BoNT-treatment improved antagonist (ankle dorsiflexion) torque-control to the same extent - which was related to the reduction in antagonist co-activity - but only rehabilitation with PRT increased maximal plantarflexion torque.
