Robot-mediated and clinical scales evaluation after upper limb botulinum toxin type A injection in children with hemiplegia.
OBJECTIVE
The aim of this pilot study was to examine changes in different aspects of impairment, including spasticity in the upper limbs, of hemiplegic children following botulinum toxin type A intervention. Progress was assessed using standard clinical measurements and a robotic device.


METHODS
Pre-post multiple baseline.


METHODS
Six children with hemiplegia.


METHODS
Botulinium toxin type A injections were administered into the affected upper limb muscles. Outcomes were evaluated before and one month after the injection. Outcome assessments included: Melbourne Scale, Modified Ashworth Scale (MAS) and Passive Range of Motion. Furthermore, a robotic device was employed as an evaluation tool.


RESULTS
Patients treated with botulinum toxin type A had significantly greater reduction in spasticity (MAS, p < 0.01), which explains an improvement in upper limb function and quality movement measured with the Melbourne Scale (p < 0.01). These improvements are consistent with robot-based evaluation results that showed statistically significant changes (p < 0.01) following botulinum toxin type A injections.


CONCLUSIONS
The upper limb performs a wide variety of movements. The multi-joint nature of the task during the robot-mediated evaluation required active control of joint interaction forces. There was good correlation between clinical scales and robotic evaluation. Hence the robot-mediated assessment may be used as an additional tool to quantify the degree of motor improvement after botulinum toxin type A injections.
Pediatric Neuro-Rehabilitation Division, Children's Hospital Bambino Gesù IRCCS Via Torre di Palidoro, IT-00050 Passoscuro (Fiumicino) Rome, Italy. flaminiafrascarelli@opbg.net
Flaminia
F
Frascarelli
Lorenzo
L
Masia
Giuseppe
G
Di Rosa
Maurizio
M
Petrarca
Paolo
P
Cappa
Enrico
E
Castelli
D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002648:Child; D005260:Female; D006429:Hemiplegia / Q000151:congenital / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D009043:Motor Activity / Q000502:physiology; D009068:Movement / Q000502:physiology; D009128:Muscle Spasticity / Q000503:physiopathology / Q000534:rehabilitation; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D020127:Recovery of Function; D012371:Robotics; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A