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To prospectively investigate the long-term effects of botulinum toxin treatment on the upper limb function and performance of school age children with spastic bilateral cerebral palsy, who have limitations in performing activities of daily living and school activities, due to spasticity of the upper extremities.
Botulinum type A toxin (BoNT-A) was injected into 24 spastic upper limbs of 15 children. We used a Modified Ashworth Scale and a Modified Tardieu Scale for the evaluation of upper limb spasticity, and Quality of Upper Extremity Skills Test (QUEST), Canadian Occupational Performance Measure (COPM), and Test of Visual-Motor Skills-Revised (TVMS-R) for the evaluation of upper limb function and performance.
Upper limb spasticity continuously decreased until the end of the one-year follow-up. Upper limb function on QUEST and COPM showed the best performance at 3 months and deteriorated slightly, but still showed a significantly better performance at 9 and 12 months than at pre-injection. In more functional nine subjects who could perform TVMS-R, the performance enhancement effects remained constant after 12 months, suggesting that the reduced spasticity led to the learning effect acquired by the repeated use of the affected upper limb.
For school age children with bilateral spastic cerebral palsy whose upper limb functions are important, BoNT-A injections seem to be of help in the performance of school activities and activities of daily living.
Citations
Method: Experimental muscle pain was induced by the injections of 5% hypertonic saline in the upper trapezius and extensor carpi radialis longus in 20 healthy volunteers respectively. Coordinative work of upper extremity was performed through the computer simulation games which were controlled by the motion of forearm pronation and supination using the steering handle. The performance scores were measured during the tasks requiring the relatively high level (driving mode) and low level (tracking mode) of coordination. Electromyographic activities were measured from the pronator teres and biceps brachii simultaneously.
Results: The performance scores were decreased after induction of muscle pain in the high coordinative task and their decreasing rate was higher in the distal muscle pain. There were no statistical differences of electromyographic activities according to the intensity and pain site and level of coordination.
Conclusion: The upper limb coordination which required high speed and complex activities was decreased in the presence of the muscle pain. (J Korean Acad Rehab Med 2003; 27: 115-120)
Objective: To evaluate the change of abnormal spontaneous activities according to the clinical and radiologic findings, and to the time course after onset in hemiplegic upper limb.
Method: We scored abnormal spontaneous activities of hemiplegic upper limb muscles (infraspinatus, deltoid, extensor carpi radialis, abductor pollicis brevis, abductor digiti minimi) in 100 hemiplegic patients without peripheral neuropathy. The abnormal spontaneous activities were evaluated according to their radiologic findings and to Brunnstrom stage and the presence of reflex sympathetic dystrophy (RSD), and the time course after the onset (A cross-sectional study). In addition we repeatedly examined 40 hemiplegic patients until 12 weeks after the onset to define the pattern of change (A prospective study).
Results: There was no significant difference in the score of abnormal spontaneous activities according to the radiologic findings. The score of abnormal spontaneous activities decreased while Brunnstrom stage progressed. In both the cross-sectional and prospective studies, we found that the abnormal spontaneous activities decreased according to the time course after the onset in the limb without RSD, but sustained in the limb with RSD.
Conclusion: Abnormal spontaneous activities decreased according to the progression of Brunnstrom stages. The hemiplegic patients with RSD showed more profuse and sustained abnormal spontaneous activities at needle EMG study of hemiplegic upper limb than the patients without RSD.
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