title: Botulinum toxin a injection into calf muscles for treatment of spastic equinus in cerebral palsy: a controlled trial comparing sonography and electric stimulation-guided injection techniques: a preliminary report.
abstract: OBJECTIVE
  To compare the clinical outcomes of two different injection techniques, one guided by electric stimulation and the other by sonography, for botulinum toxin A injection into calf muscles for the treatment of spastic equinus in children with cerebral palsy.
  
  
  METHODS
  Thirty-two children with cerebral palsy with spastic equinus gait were enrolled in separate categories according to their level under the Gross Motor Function Classification System and divided into two groups with alternate allocation: sonography-guided group and electric stimulation-guided group. Equal amounts of botulinum toxin A were injected into the gastrocnemius at four to six points in 30 children with cerebral palsy. The injection was guided by electric stimulation in 14 and by ultrasonography in 16 children. Modified Ashworth Scale, Modified Tardieu Scale, Selective Motor Control, and Physician's Rating Scale were measured at baseline, 1 mo, and 3 mos posttreatment.
  
  
  RESULTS
  Subscales of the Physician's Rating Scale (gait pattern and hindfoot position-maximum foot/floor contact during stance) significantly improved in the sonography-guided group. No statistical differences were noted in Modified Ashworth Scale, Modified Tardieu Scale, and Selective Motor Control.
  
  
  CONCLUSIONS
  Visual feedback by ultrasonography could improve the accuracy of selective neuromuscular blocking of the gastrocnemius.
authors.affiliation: Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Ilwon-dong, Kangnam-gu, Seoul, Republic of Korea.
authors.forename: Jeong-Yi
authors.initials: JY
authors.lastname: Kwon
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Hwang
authors.forename: Joon-Sung
authors.initials: JS
authors.lastname: Kim
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002547:Cerebral Palsy / Q000150:complications / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004558:Electric Stimulation / Q000379:methods*; D004863:Equinus Deformity / Q000188:drug therapy / Q000209:etiology; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D009123:Muscle Hypotonia; D009128:Muscle Spasticity / Q000188:drug therapy / Q000209:etiology; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D018084:Ultrasonography, Interventional
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A