Article

Children with cerebral palsy who walk with knee flexion during midstance are
treated with intramuscular injections of botulinum toxin A (BTX-A) to prevent
them from potential deterioration and to improve their mobility.
The present
study evaluates the effect of this treatment on the muscle activation patterns of
the rectus femoris, medial hamstrings and gastrocnemius medialis during gait.
Twenty-two children (aged 4-11 years) with cerebral palsy, who walked with knee
flexion, were randomly assigned to an intervention group (multilevel BTX-A
injections combined with comprehensive rehabilitation) or a control group (usual
care). Sagittal and frontal video recordings were made of gait, together with
simultaneous surface electromyography recordings of the rectus femoris, medial
hamstring and gastrocnemius medialis muscles, before and six weeks after
treatment. Abnormal muscle activation patterns were quantified, after
gain-normalisation, according to the root mean square difference (RMSD), which is
the difference relative to normal patterns. Six weeks after the treatment the
RMSD of the gastrocnemius medialis muscles in the intervention group changed
significantly, showing a deterioration (p<0.05). This study demonstrated that
BTX-A injections do not result in an improvement in lower limb muscle activation
patterns during gait. In spite of this lack of direct effect on muscle activation
patterns, the combination of BTX-A injections and comprehensive rehabilitation
was effective in improving gait kinematics.
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Langue : ANGLAIS