Effectiveness of resistance training in combination with botulinum toxin-A on hand and arm use in children with cerebral palsy: a pre-post intervention study
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Published on: September 23, 2018
Ann-Kristin G Elvrum1, Siri M Brændvik, Rannei Sæther
1The Clinical Services, St, Olavs University Hospital, Olav Kyrresgt, 17, N-7006, Trondheim, Norway. ann-kristin.elvrum@stolav.no
Insights
Adding resistance training to Botulinum Toxin-A (BoNT-A) injections temporarily improved muscle strength and range of motion in children with cerebral palsy (CP). However, these benefits did not enhance hand or arm function and were not sustained long-term.
Area of Science:
- Pediatric Rehabilitation
- Neuromuscular Disorders
- Biomedical Engineering
Background:
- Children with cerebral palsy (CP) often experience upper limb dysfunction.
- Botulinum Toxin-A (BoNT-A) injections are used to manage spasticity and improve function.
- The role of supplementary resistance training post-BoNT-A is not well-established.
Purpose of the Study:
- To investigate the effects of adding resistance training to BoNT-A treatment in children with CP.
- To assess the impact on upper limb function, muscle strength, tone, and range of motion.
Main Methods:
- Pilot study with ten children (9-17 years) with unilateral CP.
- Two groups: BoNT-A alone (Group B) and BoNT-A plus 8-week resistance training (Group BT).
- Evaluations included upper limb function (Melbourne, AHA), muscle strength, tone, and range of motion pre- and post-intervention.
Main Results:
- Both groups showed minor functional improvements initially; no significant difference between groups.
- Group BT demonstrated temporary improvements in muscle strength (injected and non-injected muscles) and active supination range of motion.
- No increase in muscle tone was observed; long-term differences were not significant at 5 months.
Conclusions:
- Resistance training may temporarily enhance muscle strength and active range of motion post-BoNT-A in children with CP.
- This combination did not improve hand or arm use in the short term.
- Further research is needed to confirm efficacy and optimal training approaches.
Background:
The aim of this pilot study was to examine the effects of additional resistance training after use of Botulinum Toxin-A (BoNT-A) on the upper limbs in children with cerebral palsy (CP).
Methods:
Ten children with CP (9-17 years) with unilaterally affected upper limbs according to Manual Ability Classification System II were assigned to two intervention groups. One group received BoNT-A treatment (group B), the other BoNT-A plus eight weeks resistance training (group BT). Hand and arm use were evaluated by means of the Melbourne assessment of unilateral upper limb function (Melbourne) and Assisting Hand Assessment (AHA). Measures of muscle strength, muscle tone, and active range of motion were used to assess neuromuscular body function. Measurements were performed before and two and five months after intervention start. Change scores and differences between the groups in such scores were subjected to Mann-Whitney U and Wilcoxon Signed Rank tests, respectively.
Results:
Both groups had very small improvements in AHA and Melbourne two months after BoNT-A injections, without differences between groups. There were significant, or close to significant, short-term treatment effects in favour of group BT for muscle strength in injected muscles (elbow flexion strength, p = .08) and non-injected muscles (elbow extension and supination strength, both p = .05), without concomitant increases in muscle tone. Active supination range improved in both groups, but more so in group BT (p = .09). There were no differences between the groups five months after intervention start.
Conclusions:
Resistance training strengthens non-injected muscles temporarily and may reduce short-term strength loss that results from BoNT-A injections without increasing muscle tone. Moreover, additional resistance training may increase active range of motion to a greater extent than BoNT-A alone. None of the improvements in neuromuscular impairments further augmented use of the hand and arm. Larger clinical trials are needed to establish whether resistance training can counteract strength loss caused by BoNT-A, whether the combination of BoNT-A and resistance training is superior to BoNT-A or resistance training alone in improving active range of motion, and whether increased task-related training is a more effective approach to improve hand and arm use in children with CP.
