title: Functional outcome of botulinum toxin injection of gastrocnemius and adductors in spastic hemiplegic cerebral palsied children.
abstract: OBJECTIVE
  The aim of this paper was to compare between the various effects of botulinum toxin type A (BT-A) when it is injected at gastrocnemius or adductors or at both sites in ambulant spastic hemiplegic cerebral palsy (CP) children.
  
  
  METHODS
  Sixty ambulant CP children with spastic hemiplegia were chosen. They were divided into 4 equal homogenous groups. Study groups (A, B, and C) received 3 successive injections of BT-A at 3 to 4 months interval. The injection sites were as follows: gastrocnemius for group A; adductors for group B; gastrocnemius and adductors for group C. Group D received no injections and was considered as a control group. Muscle tone and gait evaluation were conducted for every child in the BT-A groups at his entry and 6 months after the last injection dose. Also, the same evaluation protocol was conducted for every child in the control group at his entry and after 6 month's period.
  
  
  RESULTS
  When BT-A groups were compared to the control group, results showed significant improvement in muscle tone following injection in all BT-A groups. A statistically significant increase of the unaffected step length and decrease of step width and foot angle was noted in gastrocnemius group (P=0.04, P=0.003, P=0.002) respectively, as well as in gastrocnemius/adductors group (P=0.006, P=0.002, P=0.003), respectively. However, the cadence and speed of walking showed significant increase in the gastrocnemius/adductors group; only P=0.03, P=0.004 respectively. Comparing between BT-A groups, there was significant improvement in all parameters between adductors and gastrocnemius/adductors groups in favor of the last group. Moreover, there was significant improvement in muscle tone (P=0, cadence P=0.04), and speed of walking P=0.01 between gastrocnemius and gastrocnemius/adductors groups in favor of the last group; however, there was no significant difference between these 2 groups in respect to the step width P=0.96 and the foot angle P=0.92.
  
  
  CONCLUSIONS
  Our findings indicate that, in spastic hemiplegic CP, botulinum toxin has a better effect on tone reduction and improvement of gait parameters when it is given at the gastrocnemius and adductors muscles collectively.
authors.affiliation: Unit of Physical Therapy, Faculty of Rehabilitation Sciences, University of Jordan, Amman, Jordan. alaa_ibrahim40@yahoo.com
authors.forename: A I
authors.initials: AI
authors.lastname: Ibrahim
authors.forename: Z M
authors.initials: ZM
authors.lastname: Hawamdeh
authors.forename: A A
authors.initials: AA
authors.lastname: Al-Qudah
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000627:therapeutic use; D002547:Cerebral Palsy / Q000150:complications / Q000188:drug therapy* / Q000534:rehabilitation; D002648:Child; D002675:Child, Preschool; D005081:Exercise Therapy; D005684:Gait / Q000187:drug effects*; D006429:Hemiplegia / Q000188:drug therapy* / Q000209:etiology / Q000534:rehabilitation; D006615:Hip; D006801:Humans; D007273:Injections, Intramuscular; D007597:Jordan; D007866:Leg; D009129:Muscle Tonus / Q000187:drug effects*; D018482:Muscle, Skeletal / Q000187:drug effects; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A