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Changes in Motor Function in a Child with Cerebral Palsy Following Multiple Botulinum Toxin Injections: A Case Report
Nancy Lennon1, Chris Church1, Jose J Salazar-Torres1
1Department of Orthopaedics, Nemours Children's Health, 1600 Rockland Rd., Wilmington, DE 19803, USA.
Insights
This study tracked a child with spastic diplegic cerebral palsy (CP) over seven years. A decline in motor function and gait after botulinum toxin type A (BoNT-A) injections warrants further investigation.
Area of Science:
- Pediatric Physical Therapy
- Neuromuscular Disorders
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) is a common childhood motor disorder.
- Botulinum toxin type A (BoNT-A) injections are frequently used to manage spasticity in CP.
- Long-term effects of BoNT-A on gross motor function require ongoing evaluation.
Observation:
- A 7-year clinical assessment of a child with spastic diplegic CP (GMFCS level II) receiving four BoNT-A treatments.
- Serial measures included muscle strength, spasticity, range of motion, gait kinematics, and gross motor function from ages 3 to 10.
- Initial improvements were observed from ages 3 to 7, followed by a decline from ages 8 to 10.
Findings:
- The decline in gait and motor function was associated with a loss of plantarflexion strength.
- No significant improvements in spasticity or lower extremity range of motion were noted during the decline phase.
- This case highlights a potential atypical response to BoNT-A in spastic diplegic CP.
Implications:
- The findings suggest a need to consider the association between BoNT-A injections and functional decline in pediatric CP.
- Comprehensive and serial evaluations using strength, spasticity, range of motion, gait, and motor function measures are crucial.
- This approach aids in goal setting, treatment guidance, and outcome assessment for pediatric therapists and families.
Abstract:
Objective: The objective of this study was to examine 7 years of clinical physical therapy measures in a child with spastic diplegic cerebral palsy (CP) who received multiple botulinum toxin type A (BoNT-A) injections. Methods: A boy diagnosed with spastic diplegic CP, Gross Motor Function Classification System level II, received four episodes of BoNT-A from ages 4 to 10 years. Serial clinical measures of muscle strength, spasticity, lower extremity passive range of motion, gait kinematics, and gross motor function were collected in the gait analysis lab from age 3 to 10 years. Results: After improvements from ages 3 to 7 years, gait and motor function declined from ages 8 to 10 years with no improvement in spasticity or range of motion measurements. Muscle testing and gait kinematics defined a loss of plantarflexion strength. Conclusions: A decline in gross motor skills and gait is not typical for a child with spastic diplegia at age 8 years and its association with BoNT-A injections needs to be considered. This case demonstrates the importance of evaluating treatment outcomes for youth with spastic CP utilizing a set of reliable, and clinically useful measures of strength, spasticity, contracture, gait, and motor function. Critical examination of impairment and functional level measures defines goals, guides treatment, and evaluates outcomes. With this approach, pediatric therapists can empower families to make well-informed decisions.
