Botulinum Toxin Treatment on Upper Limb Function in School Age Children With Bilateral Spastic Cerebral Palsy: One Year Follow-up

OBJECTIVE: To prospectively investigate the long-term effects of botulinum toxin treatment on the upper limb function and performance of school age children with spastic bilateral cerebral palsy, who have limitations in performing activities of daily living and school activities, due to spasticity of the upper extremities. METHODS: Botulinum type A toxin (BoNT-A) was injected into 24 spastic upper limbs of 15 children. We used a Modified Ashworth Scale and a Modified Tardieu Scale for the evaluation of upper limb spasticity, and Quality of Upper Extremity Skills Test (QUEST), Canadian Occupational Performance Measure (COPM), and Test of Visual-Motor Skills-Revised (TVMS-R) for the evaluation of upper limb function and performance. RESULTS: Upper limb spasticity continuously decreased until the end of the one-year follow-up. Upper limb function on QUEST and COPM showed the best performance at 3 months and deteriorated slightly, but still showed a significantly better performance at 9 and 12 months than at pre-injection. In more functional nine subjects who could perform TVMS-R, the performance enhancement effects remained constant after 12 months, suggesting that the reduced spasticity led to the learning effect acquired by the repeated use of the affected upper limb. CONCLUSION: For school age children with bilateral spastic cerebral palsy whose upper limb functions are important, BoNT-A injections seem to be of help in the performance of school activities and activities of daily living.

Deformities of Spine and Lower Extremities in Teenagers with Cerebral Palsy

OBJECTIVE: To investigate the state of musculoskeletal deformities in spine and lower extremities in teenagers with cerebral palsy. METHOD: 79 teenagers with cerebral palsy attending special schools were examined for deformities of the spine and the lower extremities with physical examinations and radiographic studies. RESULTS: The number of cases with scoliosis was 47 (59.5%) and the mean of Cobb's angle was 21.7 degrees. There were 42 joints (26.6%) of hip subluxation and 10 joints (6.3%) of hip dislocation out of 158 hip joints. The mean of migration percentage was 53.6%. 30 participants (38.0%) had pelvic obliquity. The coxa valga appeared in 147 hip joints (93.0%), with the mean of femur neck-shaft angle was 156.0 degrees. It had a casual link with migration percentage (p<0.001). 131 knee joints (82.9%) had the increased popliteal angle and 113 knees (71.5%) had patella alta. 72 cases (91.1%) had equinus feet, and 49 cases (62.0%) had planovalgus feet deformities on radiographic studies. As the score of Gross motor function measure (GMFM) was decreased, the migration percentage (p<0.01), the Cobb's angle (p<0.01), the popliteal angle increased (p<0.001) and femur neck- shaft angle (p<0.05). CONCLUSION: Teenagers with cerebral palsy are highly risk to develop musculoskeletal deformities in their spine and the lower extremities. Therefore, a close medical inspection should be paid on this group.

Electromechanical Gait Trainer for Gait Rehabilitation for Patients with Stroke

We developed an electromechanical gait trainer for rehabilitation of the persons with disabilities, which was designed to simulate normal gait with partial body weight support. The purpose of this study was to apply it to stroke patients and to evaluate its usability. Four nonambulatory stroke patients had 20 sessions of gait training with newly developed gait trainer for 5 to 6 weeks. Knee and ankle joint angles were measured by electrogoniometer during training. Main outcome was assessed by functional ambu lation category (level 0~5). Knee and ankle joint angles during exercise in the gait trainer showed repetitive pattern of gait-like movement similar to normal gait, though it was variable among the subjects. Functional ambulation category levels after training were 2 in 3 patients and 1 in 1 patient. The electromechanical gait trainer was a useful device for gait retraining in stroke patients with severe neurologic impairments.