Influence of gait analysis on decision-marketing for lower extremity surgery

Features of success of botulinum toxin type A treatment in children with cerebral palsy: a clinical responsiveness study

K DESLOOVERE PHD A,B, G MOLENAERS MD PHD A,C, A VAN
CAMPENHOUT MD A,C, V SCHORKHUBER PT A, J DE CAT PT B

  1. 1. Clinical Motion Analysis Laboratory (CERM);
  2. 2. Department of Rehabilitaion Science;
  3. 3. Department of Musculoskeletal Sciences, University Hospital of Pellenberg, Catholic University Leuven, Belgium

Objectives: There is considerable variability in the amount of response to botulinum toxin A (BTX-A) treatment between and within patients with cerebral palsy (CP). The aim of this study was to evaluate the clinical responsiveness of BTX-A treatment in CP and to delineate features of treatment success and failure.

Design: Retrospective cohort study.

Setting: Multidisciplinary referral centre for CP.

Participants: Six hundred and thirty-nine patients have been treated with BTX-A between January 2004 and December 2006. Three hundred and seventy patients met the selection criteria (standardized evaluation pre- and 2-months post-BTX-A injections, frequent physiotherapy, and routine use of orthoses).

Method: Goal attainment scores (GAS) were calculated in order to classify and evaluate the treatment efficacy. Goals were selected by the multidisciplinary team, and the GAS was defined by an independent evaluator, based on the comparison of gait analysis data or upper limb evaluation and clinical examination pre- and 2-months post-injection (according to predefined criteria for success). The composite change score (based on 3-6 goals) was expressed as a T score with a mean equal to 50, indicating that the expected level of responsiveness was attained. Two subgroups were defined: (1) with a highly successful treatment (GAS>60); (2) with a lack of clinical response (GAS<40). Unpaired t-test or the Wilcoxon test was used to evaluate the difference between both groups for patient characteristics and components of treatment strategy.

Results: The mean GAS for the total group was 52.2 (SD 7.8), indicating that, on average, the patients achieved the treatment goals. Sixty-four treatments (17%) were found to be highly successful and for 30 treatments (8%) there was a failure of treatment. No difference could be found between both subgroups for diagnosis, number of injected muscles, total dosage, frequency of physiotherapy, or use of orthoses. A lack of response was significantly more frequently seen for children at GMFCS Level I (p<0.01). The children with a high responsiveness were significantly younger (mean 7y 4mo) compared with the children who showed an unsuccessful clinical response (mean 10y 5mo; p<0.001). Sixty-eight per cent of the positive responders received a multilevel treatment (always combined with casting), compared to 43% of the patients with treatment failure. In the latter group, a more targeted treatment on the proximal muscle groups (not always combined with casting) was frequently applied, seldom as a first treatment session.

Conclusions: Age, GMFCS level, and muscle selection seem to be crucial features of success or failure of BTX-A treatment

 
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