The effect of different physiotherapy interventions in post-BTX-A treatment of children with cerebral palsy

• Published in: European journal of paediatric neurology Vol. 16; no. 1; pp. 20 - 28
• Main Authors: Desloovere, K, De Cat, J, Molenaers, G, Franki, I, Himpens, E, Van Waelvelde, H, Fagard, K, Van den Broeck, C
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.01.2012
• Subjects: Adolescent; Botulinum toxin; Botulinum Toxins, Type A - administration & dosage; Botulinum Toxins, Type A - adverse effects; Cerebral Palsy; Cerebral Palsy - drug therapy; Cerebral Palsy - physiopathology; Cerebral Palsy - therapy; Child; Child, Preschool; Combined Modality Therapy - methods; Female; Humans; Male; Muscle Spasticity - drug therapy; Muscle Spasticity - physiopathology; Muscle Spasticity - therapy; Neurology; Neuromuscular Agents - administration & dosage; Neuromuscular Agents - adverse effects; Pediatrics; Physical Therapy Modalities; Physiotherapy; Retrospective Studies; Single-Blind Method; Treatment Outcome; Cerebral Palsy; Botulinum toxin; Physiotherapy
• ISSN: 1090-3798; 1532-2130
• DOI: 10.1016/j.ejpn.2011.08.009

Abstract Aim To distinguish the effects of different physiotherapeutic programs in a post BTX-A regime for children with Cerebral Palsy (CP). Design Retrospective, controlled intervention study. Participants and interventions A group of 38 children ( X ¯  = 7y7m, GMFCS I-III, 27 bilateral, 11 unilateral CP) receiving an individually defined Neurodevelopment Treatment (NDT) program, was matched and compared to a group of children with the same age, GMFCS and diagnosis, receiving more conventional physiotherapy treatment. All patients received selective tone-reduction by means of multilevel BTX-A injections and adequate follow-up treatment, including physiotherapy. Outcome measures Three-dimensional gait analyses and clinical examination was performed pre and two months post-injection. Treatment success was defined using the Goal Attainment Scale (GAS). Results Both groups’ mean converted GAS scores were above 50. The average converted GAS score was higher in the group of children receiving NDT than in the group receiving conventional physiotherapy ( p  < 0.05). In the NDT group, overall treatment success was achieved in 76% of the goals, compared to 67% of the goals defined for the conventional physiotherapy group. Especially for the goals based on gait analyses ( p  < 0.05) and in the group of children with bilateral CP ( p  < 0.05), treatment success was higher in the NDT group. Conclusion In a post-BTX-A regime, the short-term effects of an NDT approach are more pronouncedthan these from a conventional physiotherapy approach.