Upper-limb range of motion in children with cerebral palsy treated with botulinum neurotoxin: a population-based
Jenny Hedberg-Graff1,2, Fredrik Granström3, Marianne Arner4,5
1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Insights
Early botulinum neurotoxin-A (BoNT-A) treatment may improve passive range of motion (pROM) in children with cerebral palsy (CP). This study found early intervention is linked to better upper limb pROM outcomes over time, potentially preventing contractures.
Area of Science:
- Pediatric Rehabilitation
- Neuromuscular Disorders
- Biomechanical Analysis
Background:
- Children with cerebral palsy (CP) often experience changes in passive range of motion (pROM) in their upper limbs.
- Contractures can develop during growth, impacting motor function.
- Botulinum neurotoxin-A (BoNT-A) is used in CP management, but its long-term effects on pROM require further investigation.
Purpose of the Study:
- To investigate changes in upper limb pROM over time in children with CP.
- To compare pROM outcomes between children treated and not treated with BoNT-A.
- To assess the impact of early vs. late BoNT-A treatment on pROM.
Main Methods:
- Retrospective analysis of data from the Cerebral Palsy follow-up program and registry in Sweden (CPUP) from 2000-2017.
- Inclusion of children with spastic or dyskinetic CP, aged 1-15 years.
- Use of mixed models to analyze changes in pROM for five upper limb movements.
Main Results:
- The study included 496 children with CP; 22% received BoNT-A treatment.
- Approximately 36% developed upper limb contractures before age 15.
- Early BoNT-A treatment (before age 4) was associated with better pROM outcomes compared to later treatment.
Conclusions:
- Upper limb contractures are a significant concern, affecting one-third of children with CP during growth.
- Regular monitoring of pROM can identify early signs of muscle shortening.
- Early BoNT-A intervention shows promise in helping maintain upper limb pROM in children with CP.
Background:
Our aim was to investigate change over time of passive range of motion (pROM) in the upper limbs of children with cerebral palsy (CP), treated or not treated with botulinum neurotoxin-A (BoNT-A).
Methods:
Data from 2000 to 2017 were collected from the Cerebral Palsy follow-up program and registry in Sweden (CPUP) for children with spastic or dyskinetic CP. Mixed models were used to analyse changes in pROM from the first, until the last measurement for five upper limb movements.
Results:
The study involved 496 children with CP, aged 1-15 years (median 2 years, Interquartile range = 4). Of these, 22% had received at least one BoNT-A treatment. Contractures were classified as red (severe) or yellow (moderate) based on the Traffic Light system within CPUP. About 36% developed upper limb contractures before age 15. Early BoNT-A treatment (< 4 years) implied better pROM outcomes over time compared with later treatment, after adjusting for pROM category, CP subtype and level of manual ability.
Conclusions:
Upper limb contractures can develop during growth in children with CP affecting one third of this population. Early monitoring of pROM can detect the first signs of muscle shortening before contractures are established. Our findings suggest that early BoNT-A treatment may help maintain pROM in children with CP.
Related Concept Videos
01:17Veins of Upper Limbs
The deep venous system is primarily composed of the ulnar and radial veins. The ulnar vein, which drains the fingers through the superficial palmar venous arches, and the radial vein, which serves the palms via the deep palmar...
01:12Arteries of the Upper Limbs
01:15Bones of the Upper Limb: Ulna
01:09Bones of the Upper Limb: Radius
The radius has a nail-shaped head, and a...
01:19Bones of the Upper Limb: Humerus
00:59Range
15.9; 16.1; 15.2; 14.8; 15.8; 15.9; 16.0; 15.5
Measurements of the amount of soda in a 16-ounce can vary since different subjects record these measurements or since the exact amount - 16 ounces of liquid, was not...