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

Upper extremity function and daily functioning in children with spastic cerebral palsy following lower extremity botulinum toxin injections

T KERN-CAPELOVITCH MSC OTR A, T JARUS PHD OTR A,
A FATTAL-VALEVSK MD B

  1. 1. Department of Occupational Therapy, Stanely Steyer School of Health Professions, Sackler Faculty of Medicine;
  2. 2. The Institute for Child Development and Pediatric-Neurology Unit, `Dana’ Children’s Hospital; Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel

Background: The effects of botulinium toxin type A (BTX-A) injections to the limbs of children with cerebral palsy (CP) have been widely researched. However, there is little information documented of this effect on daily functioning. Those studies that did measure daily functioning, investigation BTX-A injections to the upper extremities (UEs).

Objective: To investigate whether BTX-A injections to the lower extremities (Es) will improve UEs and daily functioning.

Participants: Sixteen children (age 2-8y) with spastic CP diagnosed with hemiplegia, diplegia, or quadriplegia, referred to a neurology outpatient clinic for BTX-A injections.

Method: The children were seen four times. During the first assessment, 1 to 2 months before the injection, written parental consent was obtained, following a detailed explanation about the research. The second, third, and fourth assessments were performed immediately before the injection procedure, 1 month, and 5 to 6 months post-injection. Three reliable and valid tools were used: the Canadian Occupational Performance Measure and the Pediatric Evaluation of Disability Inventory (PEDI) to document satisfaction, importance of daily functioning, functional abilities, and amount of dependence on assistance; and the Quality of Upper Extremity Skills Test (QUEST). A one-way analysis of variance with repeated measures was used.

Results: Results indicated that BTX-A injections to the Les seem to have beneficial effects on functional improvement of UEs, daily functioning, and parents’ satisfaction with the child’s performance. For all measures, as expected, there was no difference between the first and second baseline tests. Improvement was documented by the third and fourth tests (p>0.05). Improvement lasted for at least 6 months and was not influenced by age, injection number, or clinical diagnosis. No improvement was noted in mobility skills and social function with caregiver assistance.

Conclusions: Reducing spasticity of Les by BTX-A injection has a primary effect on spasticity. Evidently, it has a secondary effect as well. It improves UE manual abilities, daily functioning, and parents’ satisfaction of this performance. This provides a `window of opportunity’ for children with CP in their early school years.

 
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