title: Botulinum toxin, physical and occupational therapy, and neuromuscular electrical stimulation to treat spastic upper limb of children with cerebral palsy: a pilot study.
abstract: Spasticity has been successfully managed with different treatment modalities or combinations. No information is available on the effectiveness or individual contribution of botulinum toxin type A (BTA) combined with physical and occupational therapy and neuromuscular electrical stimulation to treat spastic upper limb. The purpose of this study was to assess the effects of such treatment and to inform sample-size calculations for a randomized controlled trial. BTA was injected into spastic upper limb muscles of 10 children. They received 10 sessions of physical and occupational therapy followed by 10 sessions of neuromuscular electrical stimulation on the wrist extensors (antagonist muscles). Degree of spasticity using the Modified Ashworth scale, active range of motion, and manual function with the Jebsen hand test, were assessed. Meaningful improvement was observed in hand function posttreatment (P = 0.03). Median spasticity showed a reduction trend and median amplitude of wrist range of motion registered an increase; however, neither of these were significant (P > 0.05). There is evidence of a beneficial effect of the combined treatment. Adequate information has been obtained on main outcome-measurement variability for calculating sample size for a subsequent study to quantify the treatment effect precisely.
authors.affiliation: Department of Prosthetics and Orthotics, Instituto Nacional de Rehabilitación, Mexico City, Mexico. grodriguezreyes@gmail.com
authors.forename: Gerardo
authors.initials: G
authors.lastname: Rodríguez-Reyes
authors.forename: Aldo
authors.initials: A
authors.lastname: Alessi-Montero
authors.forename: Leticia
authors.initials: L
authors.lastname: Díaz-Martínez
authors.forename: Antonio
authors.initials: A
authors.lastname: Miranda-Duarte
authors.forename: Alberto Isaac
authors.initials: AI
authors.lastname: Pérez-Sanpablo
mesh_terms: D001696:Biomechanical Phenomena; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D004599:Electric Stimulation Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D009128:Muscle Spasticity; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D009788:Occupational Therapy; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D016059:Range of Motion, Articular; D012720:Severity of Illness Index; D016896:Treatment Outcome; D034941:Upper Extremity / Q000294:innervation / Q000503:physiopathology*; D014953:Wrist / Q000503:physiopathology
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A