| dc.description.abstract | Introduction: A common treatment for lower leg spasticity amongst children with cerebral palsy (CP) is Botulinum Toxin A (BoNT-A) injections. While the effectivity of treatment is typically assessed clinically, kinematic and neuromuscular measurements can provide insight on a more objective and physiological level.
The aim of this study was to gain a better understanding of the physiological responses of spastic lower leg muscles in children with CP to BoNT-A treatment. Furthermore, the physiological responses were evaluated against clinical assessments to determine agreement in spasticity grading.
Methods: Twenty-seven children with CP and lower leg spasticity participating in the WE study were included. Assessing each leg individually, 16 legs received BoNT-A injections in the m. gastrocnemius and m. soleus, 13 received saline (placebo), and 25 were non spastic and not treated. Kinematic (positional markers) and neuromuscular (surface electromyography: sEMG) data was collected during the clinical assessment, being passive stretch of the calf muscles at slow and fast velocity in bent and straight knee positions prior to and 4-, 12-, and 24- weeks after treatment. Outcome measures were clinical catch, range of motion (ROM), peak angular velocity, ROM to peak angular velocity, and peak of the linear envelope of sEMG of the 2 calf muscles and m. tibialis anterior.
Results: Linear mixed model analyses did not show significant changes within the BoNT-A treated spastic leg over time, nor a time-leg interaction for any of the outcome measures. When the spasticity decision of the clinical and physiological testing methods were compared, there was a lack of consensus.
Conclusion: In this study, BoNT-A did not affect any of the spasticity measures. Moreover, there was no agreement in spasticity grading between clinical assessment and physiological responses. This could be caused by the relatively low spasticity level of the participants included, methodological issues of the assessment and measures, or a low number of participants. | |
