Article

PURPOSE: Investigate the combination effects of strength training and Botulinum
Toxin Type-A (BoNT-A) on muscle strength and morphology in children with Cerebral
Palsy (CP). METHODS: Fifteen children receiving BoNT-A, classified as Spastic
Diplegic CP, GMFCS I-II, and aged 5-12 years were recruited for this study.
Randomly allocated to 10 weeks of strength training either before or after
BoNT-A, children were assessed over 6 months. Eight of the 15 children also
completed a control period. The Modified Ashworth Scale measured spasticity. The
Goal Attainment Scale (GAS) assessed achievement of functional goals. Magnetic
Resonance Imaging assessed muscle volume (MV). Instrumented dynamometry assessed
strength. RESULTS: Spasticity was significantly reduced following BoNT-A
injection (p = 0.033). Children made significant isokinetic strength gains (mean
p = 0.022, ES = 0.57) in the intervention period compared to the control period
(mean p = 0.15, ES = 0.56). Irrespective of timing, significant strength
improvements were seen immediately (10 weeks) and over 6 months for all children.
This was also the case for improvements in the GAS (immediately: mean p = 0.007,
ES = 4.17, 6 months: mean p = 0.029, ES = 0.99), and improvements in MV in all
assessed muscles. CONCLUSION: The simultaneous use of BoNT-A and strength
training was successful in spasticity reduction, improving strength and achieving
functional goals, over and above treatment with BoNT-A alone. Muscles targeted
for BoNT-A injection should be included in strength training. Implications for
Rehabilitation: Cerebral Palsy* Botulinum toxin type-A (BoNT-A) and strength
training are available interventions that, on their own have found success in
managing spasticity and muscle weakness (both significant motor impairments),
respectively in children with Cerebral Palsy (CP). * This study has demonstrated
that the concurrent treatment of BoNT-A and strength training can achieve
positive outcomes in terms of strength, spasticity and for the achievement of set
functional goals. * The results of this study show that the improved muscle
strength can be associated with hypertrophy, which could indicate the potential
role of strength training in altering the rate of muscle growth, in an aim to
improve the failure of muscle growth associated with CP. * Home based strength
training, based on a child's individual goals is shown to be successful in
improving strength and goal attainment for children with CP.

Langue : ANGLAIS