Article

The objective was to determine whether specific intrinsic (age, pattern of
cerebral palsy [CP], child's motivation) and extrinsic (number of treatments,
parenting stress) characteristics were associated with responsiveness to
botulinum toxin A (BoNT-A) injections in children with CP 3 months after
injection into the gastrocnemius muscle. METHOD: Children with hemiplegia or
diplegia recruited from a BoNT-A programme were evaluated before and 3 months
following injection of BoNT-A into the gastrocnemius. Outcome measures included
muscle tone, range of motion, gait pattern, level of ambulation, gross motor
function, and functional independence. Determinants of responsiveness to BoNT-A
considered were age, number of treatments, distribution of CP, parenting stress,
and motivation. RESULTS: Thirty-one children were recruited (17 males, 14
females)--22 with hemiplegia and nine with diplegia. Twenty-eight were classified
at Gross Motor Function Classification System (GMFCS) level I and three at level
III. The mean age was 6 years 4 months (SD 2y 11mo). Younger age (p=0.015) and
fewer number (p=0.024) of BoNT-A treatments were associated with greater change
in gross motor function. Child's motivation and parenting stress were
significantly associated with improvements in muscle tone (p=0.006-0.017),
passive range of motion (p=0.008-0.033), gait pattern (p=0.005-0.042), level of
ambulation (p=0.001-0.043), and functional independence (p=0.004-0.027).
INTERPRETATION: The results indicate that child, family, and treatment
characteristics influence the degree of responsiveness to BoNT-A treatment. The
contribution of contextual factors (personal and environmental) on responsiveness
may be underappreciated in children with CP.

Langue : ANGLAIS