The effect of botulinum toxin type A injection into the gastrocnemius muscle on sit-to-stand transfer in children with spastic diplegic cerebral palsy

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Abstract

Objective

To investigate the benefit of botulinum toxin type A injection into the ankle plantarflexor muscle on sit-to-stand transfer in children with spastic diplegic cerebral palsy.

Design

Case-control study.

Setting

Inpatients in a university-affiliated hospital.

Subjects

Forty spastic diplegic children aged from 2 to 6 years (18 children with botulinum toxin type A injection into both gastrocnemius muscles as an experimental group and 14 children without injection as a control group).

Main measures

Sit-to-stand transfer task was evaluated using a motion analyser (Vicon 370 MA with six infrared cameras). The tests were performed twice with a two- week interval. The changes in temporal, kinematic and kinetic parameters were investigated in each group.

Results

In the control group there were no significant changes in any of the measured parameters between the tests. In the experimental group, total duration (s) of sit-to-stand transfer was shortened after injection (4.35±2.49 to 2.89 ± 1.48, P<0.05). The maximal angles (degrees) of pelvic and hip joints were reduced (28.88 ± 5.53 to 26.57 ± 3.73 and 90.78 ± 8.69 to 87.23 ± 8.76) and the initial angle of ankle dorsiflexion was increased (4.41 ± 6.16 to 7.08 ± 6.09) after injection (P<0.05). The maximal moments (Nm/kg) of the hip and knee joints (0.44 ± 0.17 to 0.51 ± 0.21 and 0.13 ± 0.05 to 0.18 ± 0.14) were increased while that of the ankle joint was reduced (0.32 ± 0.09 to 0.28 ± 0.10) after injection (P<0.05). Only the cases with greater reduction of spasticity showed an improvement on kinematic and kinetic parameters.

Conclusion

Botulinum toxin type A injection into spastic ankle plantarflexors led to better accomplishment of sit-to-stand transfer in children with spastic diplegic cerebral palsy.

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