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Table 12.24 Effectiveness of Botulinum Toxin Injections for Spasticity in Children post ABI

by | Dec 12, 2018

Table 12.24 Effectiveness of Botulinum Toxin Injections for Spasticity in Children post ABI

 
Author/ Year/ Country/ Study Design/ N Methods Outcome
Guettard et al. (2009) France Case Series N=25 Population: ABI: TBI=12, Stroke=6, Brain Tumour=5, Anoxia=2; Mean Age=9.3 yr, Gender: Male=14, Female=11; Mean Time Post Injury=3.0 yr. Treatment: Patients received botulinum toxin type A (BTX-A) to lower or upper limbs, or both. Doses were given in accordance with the patient’s age and muscle size and did not exceed 10 U/kg or 300 U. All participants received physical therapy, occupational therapy and auto-exercises. Assessments were taken at baseline, 4 wk post-injection and 3 mo follow-up. Outcome Measure: Ashworth scale (AS), Zancolli scale (ZS), Range of Motion (ROM).
  1. Following the injections, spasticity was significantly reduced on the AS from baseline to 4 wk (p<0.0001).
  2. Quality of opening hand improvement significantly according to the ZS (p<0.001).
  3. Mean ROM (p=0.04) improved from pre-injection to 4 wk.
  4. Overall, 68.6% of treatment sessions led to positive results, whereas 23.6% did not have as good as expected for functional outcomes.
Van Rhijn et al. (2005) Belgium PCT N=21 Population: TBI; Age Range=2.7-19.8yr; Gender: Male=15, Female=6. Group 1 (n=4): Mean Time Post Injury=35.8 mo. Group 2 (n=10): Mean Time Post Injury=11.3 mo. Group 3 (n=7): Mean Time Post Injury=18.0mo. Treatment: Patients in Group 1 (spastic quadriparesis with impaired consciousness) received bilateral injections of botulinum toxin type A (BTX-A) to the hip adductors, knee and plantar flexors. Group 2 (patients with upper limb spasticity) received unilateral injections to the elbow, fingers, wrist flexors, and/or shoulder muscles. Group 3 patients with lower limb spasticity) received bilateral and unilateral injections to the plantar, knees, hip flexors, and/or hip adductors. Following the injections, all patients received a cast or an orthosis with Groups 2 and 3 receiving additional physiotherapy, ergotherapy and functional exercises. Assessments were conducted at baseline, and at 1, 3 and 5 mo follow-ups. Outcome Measure: Modified Ashworth Scale (MAS), range of motion (ROM) goniometry assessment.
  1. All groups demonstrated improvements in spasticity on MAS from baseline to 1mo follow-up.
  2. At 3mo follow-up, Group 1 demonstrated the greatest level of improvement in spasticity on MAS compared to baseline. Groups 2 and 3 also demonstrated improvements from baseline to 3mo follow-up.
  3. At 5 mo follow-up, Group 2 continued to demonstrate improvements in spasticity on MAS compared to baseline. Groups 1 and 3 also exhibited improvements compared to baseline, but improvements had declined in comparison to 3mo follow-up.
  4. Group 2 exhibited the greatest level of improvement in ROM with mean increases of 23o, 36o and 53o at 1 mo, 3 mo and 5 mo follow-ups compared to baseline.
  5. ROM in Group 3 improved by a mean of 4o from baseline to 1 mo follow-up but then experienced a -6o decline at 3 mo follow-up and a -3o decline at 5 mo follow-up compared to baseline ROM.
  6. Group 1 exhibited moderate improvements in ROM with mean increases of 5o, 7o and 2o at 1 mo, 3 mo and 5 mo follow-ups compared to baseline.
PEDro=Physiotherapy Evidence Database rating scale score (Moseley et al., 2002).