title: Quantitative evaluation for spasticity of calf muscle after botulinum toxin injection in patients with cerebral palsy: a pilot study.
abstract: BACKGROUND
  Cerebral palsy (CP) is the most common pediatric disease to cause motor disability. Two common symptoms in CP are spasticity and contracture. If this occurred in the ankle plantar flexors of children with CP, it will impair their gait and active daily living profoundly. Most children with CP receive botulinum toxin type A (BoNT-A) injection to reduce muscle tone, but a knowledge gap exists in the understanding of changes of neural and non-neural components of spasticity after injection. The purpose of this study was to determine if our device for quantitative modified Tardieu approach (QMTA) is a valid method to assess spasticity of calf muscles after botulinum toxin injection.
  
  
  METHODS
  In this study, we intended to develop a device for quantitative measurement of spasticity in calf muscles based on the modified Tardieu scale (MTS) and techniques of biomedical engineering. Our QMTA measures the angular displacement and resistance of stretched joint with a device that is light, portable and can be operated similar to conventional approaches for MTS. The static (R2), dynamic (R1) and R2-R1 angles derived from the reactive signals collected by the miniature sensors are used to represent the non-neural and neural components of stretched spastic muscles. Four children with CP were recruited to assess the change in spasticity in their gastrocnemius muscles before and 4 weeks after BoNT-A injection.
  
  
  RESULTS
  A simulated ankle model validated the performance of our device in measuring joint displacement and estimating the angle of catch. Data from our participants with CP showed that R2 and R2-R1 improved significantly after BoNT-A administration. It indicates both neural and non-neural components of the spastic gastrocnemius muscles improved at four weeks after BoNT-A injection in children with CP.
  
  
  CONCLUSIONS
  Our device for QMTA can objectively measure the changes in spasticity of the gastrocnemius muscle in children with cerebral palsy after BoNT-A injection.
authors.affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.|Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.|Medical Device Innovation Center, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.
authors.forename: Yu-Ching
authors.initials: YC
authors.lastname: Lin
authors.affiliation: Department of Medical Laboratory Sciences and Biotechnology, Kaohsiung Medical University, No 100, Shih-Chuan 1st Road, Kaohsiung City, 80708, Taiwan.
authors.forename: I-Ling
authors.initials: IL
authors.lastname: Lin
authors.affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.|School of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.
authors.forename: Te-Feng Arthur
authors.initials: TF
authors.lastname: Chou
authors.affiliation: Department of Physical Therapy, I-Shou University, No.8, Yida Rd., Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan, ROC. hmlee@isu.edu.tw.
authors.forename: Hsin-Min
authors.initials: HM
authors.lastname: Lee
mesh_terms: D061725:Accelerometry / Q000295:instrumentation*; D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005684:Gait / Q000187:drug effects; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000188:drug therapy / Q000209:etiology; D018482:Muscle, Skeletal / Q000187:drug effects; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010865:Pilot Projects
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin; Cerebral palsy; Modified Tardieu scale; Quantitative measurement; Spasticity