title: Determinants of responsiveness to botulinum toxin, casting, and bracing in the treatment of spastic equinus in children with cerebral palsy.
abstract: OBJECTIVE
  The objective was to determine whether specific intrinsic (age, pattern of cerebral palsy [CP], child's motivation) and extrinsic (number of treatments, parenting stress) characteristics were associated with responsiveness to botulinum toxin A (BoNT-A) injections in children with CP 3 months after injection into the gastrocnemius muscle.
  
  
  METHODS
  Children with hemiplegia or diplegia recruited from a BoNT-A programme were evaluated before and 3 months following injection of BoNT-A into the gastrocnemius. Outcome measures included muscle tone, range of motion, gait pattern, level of ambulation, gross motor function, and functional independence. Determinants of responsiveness to BoNT-A considered were age, number of treatments, distribution of CP, parenting stress, and motivation.
  
  
  RESULTS
  Thirty-one children were recruited (17 males, 14 females)--22 with hemiplegia and nine with diplegia. Twenty-eight were classified at Gross Motor Function Classification System (GMFCS) level I and three at level III. The mean age was 6 years 4 months (SD 2y 11mo). Younger age (p=0.015) and fewer number (p=0.024) of BoNT-A treatments were associated with greater change in gross motor function. Child's motivation and parenting stress were significantly associated with improvements in muscle tone (p=0.006-0.017), passive range of motion (p=0.008-0.033), gait pattern (p=0.005-0.042), level of ambulation (p=0.001-0.043), and functional independence (p=0.004-0.027).
  
  
  CONCLUSIONS
  The results indicate that child, family, and treatment characteristics influence the degree of responsiveness to BoNT-A treatment. The contribution of contextual factors (personal and environmental) on responsiveness may be underappreciated in children with CP.
authors.affiliation: Shriners Hospitals for Children, Montreal, Quebec, Canada. ryap@shrinenet.org
authors.forename: Rita
authors.initials: R
authors.lastname: Yap
authors.forename: Annette
authors.initials: A
authors.lastname: Majnemer
authors.forename: Thierry
authors.initials: T
authors.lastname: Benaroch
authors.forename: Marie-Andree
authors.initials: MA
authors.lastname: Cantin
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications / Q000523:psychology; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003657:Decision Making; D051341:Dependent Ambulation; D004185:Disability Evaluation; D004863:Equinus Deformity / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular / Q000379:methods; D008297:Male; D009042:Motivation; D018482:Muscle, Skeletal / Q000187:drug effects / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D019637:Orthopedic Procedures / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods; D010290:Parents / Q000523:psychology; D016059:Range of Motion, Articular; D012720:Severity of Illness Index
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A