title: Combining strength training and botulinum neurotoxin intervention in children with cerebral palsy: the impact on muscle morphology and strength.
abstract: OBJECTIVE
  Investigate the combination effects of strength training and Botulinum Toxin Type-A (BoNT-A) on muscle strength and morphology in children with Cerebral Palsy (CP).
  
  
  METHODS
  Fifteen children receiving BoNT-A, classified as Spastic Diplegic CP, GMFCS I-II, and aged 5-12 years were recruited for this study. Randomly allocated to 10 weeks of strength training either before or after BoNT-A, children were assessed over 6 months. Eight of the 15 children also completed a control period. The Modified Ashworth Scale measured spasticity. The Goal Attainment Scale (GAS) assessed achievement of functional goals. Magnetic Resonance Imaging assessed muscle volume (MV). Instrumented dynamometry assessed strength.
  
  
  RESULTS
  Spasticity was significantly reduced following BoNT-A injection (p = 0.033). Children made significant isokinetic strength gains (mean p = 0.022, ES = 0.57) in the intervention period compared to the control period (mean p = 0.15, ES = 0.56). Irrespective of timing, significant strength improvements were seen immediately (10 weeks) and over 6 months for all children. This was also the case for improvements in the GAS (immediately: mean p = 0.007, ES = 4.17, 6 months: mean p = 0.029, ES = 0.99), and improvements in MV in all assessed muscles.
  
  
  CONCLUSIONS
  The simultaneous use of BoNT-A and strength training was successful in spasticity reduction, improving strength and achieving functional goals, over and above treatment with BoNT-A alone. Muscles targeted for BoNT-A injection should be included in strength training.
  
  
  CONCLUSIONS
  Cerebral Palsy• Botulinum toxin type-A (BoNT-A) and strength training are available interventions that, on their own have found success in managing spasticity and muscle weakness (both significant motor impairments), respectively in children with Cerebral Palsy (CP). • This study has demonstrated that the concurrent treatment of BoNT-A and strength training can achieve positive outcomes in terms of strength, spasticity and for the achievement of set functional goals. • The results of this study show that the improved muscle strength can be associated with hypertrophy, which could indicate the potential role of strength training in altering the rate of muscle growth, in an aim to improve the failure of muscle growth associated with CP. • Home based strength training, based on a child's individual goals is shown to be successful in improving strength and goal attainment for children with CP.
authors.affiliation: School of Sport Science, Exercise & Health, The University of Western Australia, Perth, Australia. Sian.Williams@health.wa.gov.au
authors.forename: Sîan A
authors.initials: SA
authors.lastname: Williams
authors.forename: Catherine
authors.initials: C
authors.lastname: Elliott
authors.forename: Jane
authors.initials: J
authors.lastname: Valentine
authors.forename: Anna
authors.initials: A
authors.lastname: Gubbay
authors.forename: Peter
authors.initials: P
authors.lastname: Shipman
authors.forename: Siobhan
authors.initials: S
authors.lastname: Reid
mesh_terms: D001315:Australia; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000627:therapeutic use; D002547:Cerebral Palsy / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D035002:Lower Extremity / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009128:Muscle Spasticity / Q000188:drug therapy*; D018482:Muscle, Skeletal / Q000473:pathology; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D055070:Resistance Training / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A