A multilevel approach to botulinum toxin type A treatment of the (ilio)psoas in spasticity in cerebral palsy |
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Authors: | Guy Molenaers Marijke Eyssen Kaat Desloovere Ilse Jonkers Paul De Cock |
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Institution: | Department of Orthopaedic Surgery, Faculty of Physical Education and Physical Therapy, University Hospital Leuven, Belgium;Department of Neuro Paediatrics, Faculty of Physical Education and Physical Therapy, University Hospital Leuven, Belgium;Gait Analysis Laboratory, Faculty of Physical Education and Physical Therapy, University Hospital Leuven, Belgium;Department of Physical Therapy, Faculty of Physical Education and Physical Therapy, University Hospital Leuven, Belgium |
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Abstract: | In spasticity, flexion deformity of the hip is frequently associated with contracture or hyper-reflexia of the psoas muscle. Botulinum toxin type A (BTX-A) has been used for some considerable time in the management of paediatric gait disorders. We have been using a multilevel approach to manage spasticity in cerebral palsy for several years, the combination of gait analysis and clinical evaluation being important for the selection of target muscles for BTX-A injections. Twenty cerebral palsy children (12 female) with spasticity were treated with BTX-A injections (BOTOX® mean dose, 2 U/kg body weight) into the psoas muscle. Patients were monitored using range of motion measurements of maximal hip extension, clinical estimates of hypertonia in the hip flexors, gait analysis (three-dimensional kinematics and kinetics) and surface electromyography of major lower limb muscles. Full gait analysis was carried out on 12 of the patients. Significant clinical improvements were observed following 15 of the 21 psoas treatments. Furthermore, the kinematics results of gait analysis showed improvement in one or more parameters in nine of the 12 patients. In conclusion, we have demonstrated the value of a multilevel approach to BTX-A treatment in the management of spasticity in children with cerebral palsy. |
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Keywords: | erebral palsy spasticity children botulinum toxin type A psoas multilevel |
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