Use of three-dimensional kinematic analysis following upper limb botulinum toxin A for children with hemiplegia.
OBJECTIVE
To examine whether three-dimensional (3-D) kinematic analysis can detect changes in upper limb tasks (reach and hand-to-mouth) in children with hemiplegia, following upper limb botulinum toxin A injections.


METHODS
Ten children with hemiplegic cerebral palsy (7 males, 3 females, aged 9-17 years). Subjects received botulinum toxin A (Botox) injections into elbow forearm muscles combined with 6 weeks of occupational therapy. Participants completed a 3-D kinematic analysis of two upper limb tasks, Melbourne Assessment of Unilateral Upper Limb Function and modified Ashworth scores measured at baseline, 2, 6 and 12 weeks post-injection.


RESULTS
Post-injections, elbow flexor muscle tone was reduced for 12 weeks (p < 0.05). Group differences in active range of motion during 3-D analysis tasks could not be demonstrated at any time post-intervention. However, individual analyses found that at 2 weeks post-injection, three subjects had >15 degrees increases in active elbow extension and six subjects showed an increase of >25 degrees in forearm supination during performance of the reach and hand-to-mouth tasks, respectively.


CONCLUSIONS
3-D kinematics can detect changes in active movements during functional tasks following botulinum toxin A injections, suggesting this could be a potential objective outcome measure in a clinical trial.
Mackey
A H
AH
Department of Surgery, University of Auckland, Auckland, New Zealand. a.mackey@auckland.ac.nz
Miller
F
F
Walt
S E
SE
Waugh
M-C
MC
Stott
N S
NS
D000293:Adolescent; D001696:Biomechanical Phenomena; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D004185:Disability Evaluation; D004550:Elbow / Q000503:physiopathology; D005260:Female; D006429:Hemiplegia / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D018482:Muscle, Skeletal / Q000187:drug effects / Q000294:innervation / Q000503:physiopathology; D009460:Neurologic Examination / Q000379:methods; D009465:Neuromuscular Agents / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011237:Predictive Value of Tests; D016059:Range of Motion, Articular / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A