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Botulinum Toxin Type A Injections Impact Hamstring Muscles and Gait Parameters in Children with Flexed Knee Gait

Seung Ki Kim1, Dong Wook Rha1, Eun Sook Park1

  • 1Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.

Toxins
|March 4, 2020
PubMed

Insights

Botulinum toxin type A (BoNT-A) injections in the hamstring muscles improved knee extension and pelvic tilt in children with spastic cerebral palsy (CP) and flexed knee gait (FKG). This treatment enhanced gait kinematics and muscle function.

Area of Science:

  • Neurology
  • Orthopedics
  • Rehabilitation Medicine

Background:

  • Spastic cerebral palsy (CP) often presents with flexed knee gait (FKG), characterized by limited knee extension during the stance phase.
  • Hamstring spasticity is a common contributor to FKG, impacting overall gait kinematics and motor function in children with CP.

Purpose of the Study:

  • To investigate the efficacy of botulinum toxin type A (BoNT-A) injections into the medial hamstring muscles for improving gait kinematics in children with spastic CP and FKG.
  • To assess the impact of BoNT-A on muscle-tendon length, lengthening velocity, and clinical measures of spasticity and motor function.

Main Methods:

  • A prospective study involving 29 children with spastic CP (GMFCS I-III) and FKG who received ultrasound-guided BoNT-A injections into the semitendinosus and semimembranosus (SM) muscles.
  • Comprehensive assessments included the Gross Motor Function Measure (GMFM), Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), 3D gait analysis, and musculoskeletal modeling to calculate SM muscle-tendon parameters at baseline, 4, and 16 weeks post-injection.

Main Results:

  • Significant improvements were observed in GMFM, MAS, and MTS scores at both 4 and 16 weeks post-injection.
  • A significant increase in maximum knee extension during stance was noted at 4 weeks, alongside increased SM lengthening velocity during swing at 16 weeks.
  • Increased anterior pelvic tilt was observed at 4 weeks, and a decrease in hip internal rotation was seen in children with pre-existing excessive hip rotation.

Conclusions:

  • BoNT-A injection into the medial hamstrings is an effective treatment for improving knee extension and anterior pelvic tilt in children with spastic CP and FKG.
  • The treatment positively influences gait kinematics, including muscle-tendon dynamics, and reduces spasticity, contributing to improved motor function in this population.

Keywords:
botulinum toxin type Acerebral palsychildrenhamstring musclesinjectionknee flexion gaitsemimembranosus muscle

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