Expert consensus on physical therapist intervention after botulinum toxin a injection for children with cerebral palsy.

PURPOSE: The purpose of this study was to gather expert consensus on physical therapist (PT) intervention after lower extremity botulinum toxin A (BtA) injection(s) for children with cerebral palsy (CP) and lower extremity spasticity. This study also examined differences in expert opinion on intervention for two groups of children with CP and differing levels of functional ability. METHODS: The Guide to Physical Therapist Practice was used to develop a questionnaire. Sixty-two therapists identified as experts in the field of pediatric physical therapy rated the importance of the three PT intervention components and the seven types of direct intervention from Neuromuscular Pattern 5A for both groups. The Wilcoxon signed rank test was used to identify differences in expert responses between the groups. Experts also ranked the importance of specific intervention strategies. Consensus criteria were used to determine the importance of interventions. RESULTS: All three intervention components and four direct interventions (Therapeutic Exercise; Functional Training-Self-Care; Functional Training-Community and Work; and Prescription of Devices/Equipment) met consensus criteria for both groups. Significant differences between groups were found for Patient/Client-Related Instruction and Direct Interventions and for Therapeutic Exercise, Functional Training in Self-Care, Functional Training-Community and Work, and Electrotherapeutic Modalities, suggesting that these items were more important for children with greater functional abilities. Twenty (35%) specific intervention strategies met consensus criteria for one or both groups. DISCUSSION AND CONCLUSIONS: All three intervention components and four direct interventions in Neuromuscular Pattern 5A are important in the PT plan of care after botulinum toxin A injection for children with CP and lower extremity spasticity. Functional ability influences therapists' intervention choices.

The incidence and important of post-suxamethonium pain in Barbadian patients

A survey of the incidence of post-suxamethonium muscle pain and/or stiffness (PSPS) following its administration for muscle relaxation during anaesthesia was carried out at the Queen Elizabeth Hospital in Barbados. It revealed a much lower overall incidence of PSPS (10.9 per cent) than usually reported. The incidence of severe PSPS of 2.52 per cent was also lower than in other reports. This may suggest a geographical or population difference. The relationship of PSPS to such factors as the degree of fasciculation, postoperative activity, type of operation, dose of suxamethonium, serum cholinesterase levels and dibucaine numbers and the use of the thiopentone and non--depolarising relaxants was also investigated. No relationship could be found. The predominance of PSPS in women between 21 and 30 years of age and those over 71 years of age found in Barbados merits further study. (AU)