Upper-extremity Spasticity-reducing Treatment in Adjunct to Movement Training and Orthoses in Children with Cerebral...

Area of Science:

• Pediatric Rehabilitation
• Neurology
• Orthopedics

Background:

• Children with severe cerebral palsy (CP) often experience upper-extremity spasticity impacting hand function.
• Early and consistent habilitation is crucial for managing CP-related motor impairments.
• The long-term effects of early versus delayed upper-extremity treatment in severe CP are not fully understood.

Purpose of the Study:

• To compare changes in passive wrist extension with fingers extended (PWE-FE) and hand function over 20 years in children with severe CP.
• To evaluate the impact of early botulinum neurotoxin type A treatment and intervention programs versus delayed treatment.

Main Methods:

• A retrospective study of 25 children with severe CP over a 20-year period.
• Comparison of three groups: early intervention (Group 1), no early treatment (Group 2), and delayed treatment (Group 3).
• Assessment of passive wrist extension with fingers extended (PWE-FE) and hand function scores.

Main Results:

• Children receiving delayed treatment (Group 3) exhibited significantly poorer PWE-FE values and hand function scores compared to those receiving early intervention (Group 1).
• Group 3 showed more critical and less normal PWE-FE values for both wrists.
• Early intervention (Group 1) was associated with better preservation of passive range of motion and improved hand function.

Conclusions:

• Early and systematic upper-extremity treatment, including botulinum neurotoxin type A and movement training/orthoses, may prevent critical loss of wrist range of motion in children with severe CP.
• Initiating treatment before age 7 appears beneficial for promoting hand function development.
• Findings cautiously suggest that early intervention is key to optimizing functional outcomes in severe pediatric cerebral palsy.