title: Sonographic and clinical effects of botulinum toxin Type A combined with extracorporeal shock wave therapy on spastic muscles of children with cerebral palsy.
abstract: OBJECTIVE
  The aim of this study was to compare the combined sonographic and clinical effects of botulinum toxin type A (BoNT-A) and extracorporeal shock wave therapy (ESWT) versus BoNT-A alone in children with cerebral palsy.
  
  
  METHODS
  Ten children with spastic cerebral palsy were randomly assigned to one of two groups. Group 1 received BoNT-A injection into the spastic muscles of the affected limbs plus three ESWT sessions. Group 2 received BoNT-A alone. Assessment was performed before and 1 month after injection. Sonographic outcomes were injected muscles echo intensity and their hardness percentage, and clinical outcomes the modified Ashworth scale and the Tardieu scale.
  
  
  RESULTS
  At 1-month evaluation, significant differences in the injected muscles percentage of hardness (P = 0.021) and the modified Ashworth scale (P = 0.001) were found between groups.
  
  
  CONCLUSIONS
  Our results support the hypothesis that the combined effects of BoNT-A and ESWT derive from their respective action on neurological and non-neural rheological components in spastic muscles.
authors.affiliation: a Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological , Biomedical and Movement Sciences, University of Verona , Verona , Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Picelli
authors.affiliation: a Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological , Biomedical and Movement Sciences, University of Verona , Verona , Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: La Marchina
authors.affiliation: b Polyfunctional Centre "Don Calabria" , Verona , Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gajofatto
authors.affiliation: a Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological , Biomedical and Movement Sciences, University of Verona , Verona , Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Pontillo
authors.affiliation: b Polyfunctional Centre "Don Calabria" , Verona , Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Vangelista
authors.affiliation: b Polyfunctional Centre "Don Calabria" , Verona , Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Filippini
authors.affiliation: c Physical and Rehabilitative Medicine , University Hospital "Maggiore della Carità" , Novara , Italy.|d Department of Health Sciences , Piemonte Orientale University , Novara , Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Baricich
authors.affiliation: c Physical and Rehabilitative Medicine , University Hospital "Maggiore della Carità" , Novara , Italy.|d Department of Health Sciences , Piemonte Orientale University , Novara , Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Cisari
authors.affiliation: a Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological , Biomedical and Movement Sciences, University of Verona , Verona , Italy.|e Neurorehabilitation Unit , Hospital Trust of Verona , Verona , Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Smania
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000494:pharmacology*; D002547:Cerebral Palsy / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000494:pharmacology*; D016037:Single-Blind Method; D013016:Sound
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Elasticity imaging techniques; high-energy shock waves; physical therapy modalities; ultrasonography