Mulligan Hilda, Wilmshurst Erin
School of Physiotherapy, University of Otago, Christchurch, New Zealand.
Pediatr Phys Ther. 2006 Spring;18(1):39-48. doi: 10.1097/01.pep.0000202252.92562.4c.
Botulinum toxin A is a relatively new, noninvasive treatment option for children with cerebral palsy, providing an effective, short-term intervention to reduce spasticity. It is used as an adjunct to other management including physiotherapy. The purpose of this case report is to evaluate assessment and management by physiotherapy following Botox injections to hamstring and gastrocnemius muscles.
Examination of function and impairment for a 3.5-year-old child with spastic diplegia included the Gross Motor Function Measure, Goal Attainment Scaling, the Physician Rating Scale of gait, dynamic and passive range of movement, and selective motor control. Physiotherapy intervention was play based and occurred at home, at a preschool, and in the therapist's usual clinic setting, twice a week for the first five weeks, then once a week for another five weeks. Intervention consisted of whole and part practice of functional skills using closed and open chain exercises through the full available muscle range.
The child showed increased ability in function; however, impairment level results were inconsistent and may not be effective at discerning change in a clinical setting.
An increased level of physiotherapy was easily implemented by frequent and clear communication with those directly involved with the child's everyday activities. This is believed to have contributed to the successful outcomes seen.
