Neurorehabilitation with versus without resistance training after botulinum toxin treatment in children with cerebral palsy: a randomized pilot study.
OBJECTIVE
To compare the effects of physical rehabilitation with (PRT) and without (CON) progressive resistance training following treatment of spastic plantarflexors with botulinum toxin type A (BoNT) in children with cerebral palsy (CP).


METHODS
Fourteen children with CP performed supervised PRT (n=7) or CON (n=7) two times per week for 12 weeks, following the BoNT-treatment. Outcome measurements were performed at baseline (pre BoNT), and 4 and 12 weeks post BoNT. They consisted of: ankle muscle function (maximal torque and submaximal torque steadiness of isometric ankle dorsi- and plantarflexion and associated ankle muscle [EMG] activity), gait function (3-dimensional gait analysis), balance function (sway analysis), gross motor function (GMFM-66), and spasticity (modified Ashworth).


RESULTS
Submaximal torque control (torque steadiness) of isometric dorsiflexion improved similarly in the two groups, and the improvement was related to the reduction in antagonist (soleus) co-activity (P< 0.05). Maximal plantarflexion torque increased after PRT, whereas a reduction was seen after CON (P< 0.05). No changes in function were observed.


CONCLUSIONS
Both types of physical rehabilitation in combination with BoNT-treatment improved antagonist (ankle dorsiflexion) torque-control to the same extent - which was related to the reduction in antagonist co-activity - but only rehabilitation with PRT increased maximal plantarflexion torque.
Gait Analysis Laboratory, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark. Thomas.Bandholm@hvh.regionh.dk
Thomas
T
Bandholm
Bente R
BR
Jensen
Lone M
LM
Nielsen
Helle
H
Rasmussen
Jesper
J
Bencke
Derek
D
Curtis
Søren A
SA
Pedersen
Stig
S
Sonne-Holm
D000704:Analysis of Variance; D000843:Ankle Joint / Q000503:physiopathology; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000534:rehabilitation*; D002648:Child; D004185:Disability Evaluation; D004576:Electromyography; D005260:Female; D005684:Gait / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010865:Pilot Projects; D055070:Resistance Training / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A