Influence of botulinum toxin therapy on postural control and lower limb intersegmental coordination in children with spastic cerebral palsy.
Botulinum toxin injections may significantly improve lower limb kinematics in gait of children with spastic forms of cerebral palsy. Here we aimed to analyze the effect of lower limb botulinum toxin injections on trunk postural control and lower limb intralimb (intersegmental) coordination in children with spastic diplegia or spastic hemiplegia (GMFCS I or II). We recorded tridimensional trunk kinematics and thigh, shank and foot elevation angles in fourteen 3-12 year-old children with spastic diplegia and 14 with spastic hemiplegia while walking either barefoot or with ankle-foot orthoses (AFO) before and after botulinum toxin infiltration according to a management protocol. We found significantly greater trunk excursions in the transverse plane (barefoot condition) and in the frontal plane (AFO condition). Intralimb coordination showed significant differences only in the barefoot condition, suggesting that reducing the degrees of freedom may limit the emergence of selective coordination. Minimal relative phase analysis showed differences between the groups (diplegia and hemiplegia) but there were no significant alterations unless the children wore AFO. We conclude that botulinum toxin injection in lower limb spastic muscles leads to changes in motor planning, including through interference with trunk stability, but a combination of therapies (orthoses and physical therapy) is needed in order to learn new motor strategies.
Centre d'Analyse du Mouvement, Hôpital Brugmann, Université Libre de Bruxelles, Brussels B-1020, Belgium. marc.degelaen@huderf.be
Marc
M
Degelaen
Ludo
L
de Borre
Eric
E
Kerckhofs
Linda
L
de Meirleir
Ronald
R
Buyl
Guy
G
Cheron
Bernard
B
Dan
D001259:Ataxia / Q000188:drug therapy*; D001696:Biomechanical Phenomena; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008297:Male; D009048:Motor Skills / Q000187:drug effects*; D004856:Postural Balance / Q000187:drug effects*; D016896:Treatment Outcome; D016138:Walking
D019274:Botulinum Toxins, Type A