Effects of Botulinum injections on the development of arm and hand function in children with unilateral spastic cerebral palsy

2013 ◽  
Author(s):  
Kate Himmelmann
Keyword(s):  
Cerebral Palsy ◽  
Hand Function ◽  
Spastic Cerebral Palsy

scholarly journals DEVELOPMENT OF MOTOR FUNCTIONS AND MANUAL ABILITIES IN PEDIATRIC PATIENTS WITH SPASTIC CEREBRAL PALSY AFTER BOTULINUM TOXIN TREATMENT AND COMPLEX REHABILITATION

2013 ◽  
Vol 68 (11) ◽  
pp. 38-48
Author(s):  
O. A. Klochkova ◽  
A. L. Kurenkov ◽  
L. S. Namazova-Baranova ◽  
A. M. Mamed'yarov ◽  
K. V. Zherdev
Keyword(s):  
Cerebral Palsy ◽  
Botulinum Toxin ◽  
Motor Development ◽  
Botulinum Toxin A ◽  
Hand Function ◽  
Spastic Cerebral Palsy ◽  
Toxin A ◽  
Botulinum Toxin Therapy ◽  
Botulinum Toxin Treatment ◽  
Development Assessment

Aim: to investigate the dynamic of general motor function and manual abilities in children with spastic forms of cerebral palsy (CP) after complex rehabilitation combined with single and repeated injections of botulinum toxin A (BTA). Patients and methods: the article presents 18 month follow-up of 52 patients with mono- and bilateral spastic forms of CP after single and multiple injections of botulinum toxin A and complex rehabilitation/ Patients received totally 74 injection sessions: 17 (32,7%) children — twice, 5 (9,6%) children — three times. Motor development assessment was done according to the GMFCS and GMFMS-88 scales and centile curves of normal motor development connected with these scales, hand function was classified according to the MACS scale. For the first time results of botulinum toxin therapy and rehabilitation were compared with the natural motor development of patients with different levels of motor disturbances according to centile tables. Results: patients with bilateral cerebral palsy improved slowly than hemiparetic and changes lasted for longer period. Level according to the MACS scale didn’t depend on the gestational age of the patients, was higher in children with hemiparesis and changed for 1 level in 4 (7,7%) patients after the first botulinum toxin A injections. 

Effectiveness of Hand-Arm Bimanual Intensive Therapy on Hand Function among Children with Unilateral Spastic Cerebral Palsy: A Meta-Analysis

2020 ◽  
Vol 83 (2) ◽  
pp. 131-137
Author(s):  
Khalid Alahmari ◽  
Jaya Shanker Tedla ◽  
Devika Rani Sangadala ◽  
Debjani Mukherjee ◽  
Ravi Shankar Reddy ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Effect Size ◽  
Meta Analysis ◽  
Hand Function ◽  
Intensive Therapy ◽  
Spastic Cerebral Palsy ◽  
Randomized Controlled ◽  
Constraint Induced Movement Therapy ◽  
Evidence Database ◽  
The Individual

Background: Hand-arm bimanual intensive therapy (HABIT) has been shown to be an effective method for improving upper-extremity function. However, owing to ambiguity within the evidence of HABIT’s effects on hand function among children with unilateral spastic cerebral palsy (CP), this meta-analysis sought to elucidate whether the same was true in this patient population. Summary: A computerized database search yielded 468 studies. After meticulous scrutiny and screening of these studies according to the selection criteria, 4 full-text articles were included in the meta-analysis. All 4 studies underwent a methodological quality assessment according to the Physiotherapy Evidence Database Scale (PEDro), with a score of greater than 8. Five comparisons were then made involving the 4 selected randomized controlled trials (RCTs). The effect size was measured using the correlation coefficient (r value). The effect sizes of the individual studies were 0.006, 0.03, 0.04, 0.22, and 0.15. The total effect size was 0.06. Key Message: This meta-analysis determined that there is a trivial benefit using HABIT when compared to constraint-induced movement therapy or structured and unstructured bimanual therapy in pediatric patients with unilateral spastic CP. More RCTs are needed to substantiate our evidence.

scholarly journals Improvements in Upper Extremity Function Following Intensive Training Are Independent of Corticospinal Tract Organization in Children With Unilateral Spastic Cerebral Palsy: A Clinical Randomized Trial

2021 ◽  
Vol 12 ◽  
Author(s):  
Kathleen M. Friel ◽  
Claudio L. Ferre ◽  
Marina Brandao ◽  
Hsing-Ching Kuo ◽  
Karen Chin ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Upper Extremity ◽  
Corticospinal Tract ◽  
Hand Function ◽  
Performance Measure ◽  
Connectivity Pattern ◽  
Spastic Cerebral Palsy ◽  
Clinical Trial Registration ◽  
Intensive Training ◽  
Bimanual Training

Background/Objectives: Intensive training of the more affected upper extremity (UE) has been shown to be effective for children with unilateral spastic cerebral palsy (USCP). Two types of UE training have been particularly successful: Constraint-Induced Movement Therapy (CIMT) and Bimanual training. Reorganization of the corticospinal tract (CST) early during development often occurs in USCP. Prior studies have suggested that children with an ipsilateral CST controlling the affected UE may improve less following CIMT than children with a contralateral CST. We tested the hypothesis that improvements in UE function after intensive training depend on CST laterality.Study Participants and Setting: Eighty-two children with USCP, age 5 years 10 months to 17 years, University laboratory setting.Materials/Methods: Single-pulse transcranial magnetic stimulation (TMS) was used to determine each child's CST connectivity pattern. Children were stratified by age, sex, baseline hand function and CST connectivity pattern, and randomized to receive either CIMT or Bimanual training, each of which were provided in a day-camp setting (90 h). Hand function was tested before, immediately and 6 months after the intervention with the Jebsen-Taylor Test of Hand Function, the Assisting Hand Assessment, the Box and Block Test, and ABILHAND-Kids. The Canadian Occupational Performance Measure was used to track goal achievement and the Pediatric Evaluation of Disability Inventory was used to assess functioning in daily living activities at home.Results: In contrast to our hypothesis, participants had statistically similar improvements for both CIMT and Bimanual training for all measures independent of their CST connectivity pattern (contralateral, ipsilateral, or bilateral) (p < 0.05 in all cases).Conclusions/Significance: The efficacy of CIMT and Bimanual training is independent of CST connectivity pattern. Children with an ipsilateral CST, previously thought to be maladaptive, have the capacity to improve as well as children with a contralateral or bilateral CST following intensive CIMT or Bimanual training.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02918890.

scholarly journals Anticipatory Motor Planning and Control of Grasp in Children with Unilateral Spastic Cerebral Palsy

2021 ◽  
Vol 11 (9) ◽  
pp. 1161
Author(s):  
Jennifer Gutterman ◽  
Trevor Lee-Miller ◽  
Kathleen M. Friel ◽  
Katherine Dimitropoulou ◽  
Andrew M. Gordon
Keyword(s):  
Cerebral Palsy ◽  
Right Hemisphere ◽  
Hand Function ◽  
Precision Grip ◽  
Motor Planning ◽  
Spastic Cerebral Palsy ◽  
Planning And Control ◽  
Hemisphere Lesion ◽  
Lift Off ◽  
And Control

Children with unilateral spastic cerebral palsy (USCP) have impairments in motor planning, impacting their ability to grasp objects. We examined the planning of digit position and force and the flexibility of the motor system in covarying these during object manipulation. Eleven children with a left hemisphere lesion (LHL), nine children with a right hemisphere lesion (RHL) and nine typically developing children (controls) participated in the study. Participants were instructed to use a precision grip with their dominant/less affected hand to lift and keep an object level, with either a left, centered or right center of mass (COM) location. Digit positions, forces, compensatory torque and object roll where measured. Although children with USCP generated a compensatory torque and modulated digit placement by lift-off, their index finger was either collinear or higher than the thumb, regardless of COM location, leading to larger rolls after lift-off especially for the RHL group. The findings suggest that while the kinetics of grasp control is intact, the kinematics of grasp control is impaired. This study adds to the understanding of the underlying mechanisms of anticipatory planning and control of grasp in children with USCP and may provide insights on how to improve hand function in children with USCP.

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