School of Sport Science, Exercise & Health, The University of Western Australia, Perth, Australia.
Disabil Rehabil. 2013 Apr;35(7):596-605. doi: 10.3109/09638288.2012.711898. Epub 2012 Aug 28.
Investigate the combination effects of strength training and Botulinum Toxin Type-A (BoNT-A) on muscle strength and morphology in children with Cerebral Palsy (CP).
Fifteen children receiving BoNT-A, classified as Spastic Diplegic CP, GMFCS I-II, and aged 5-12 years were recruited for this study. Randomly allocated to 10 weeks of strength training either before or after BoNT-A, children were assessed over 6 months. Eight of the 15 children also completed a control period. The Modified Ashworth Scale measured spasticity. The Goal Attainment Scale (GAS) assessed achievement of functional goals. Magnetic Resonance Imaging assessed muscle volume (MV). Instrumented dynamometry assessed strength.
Spasticity was significantly reduced following BoNT-A injection (p = 0.033). Children made significant isokinetic strength gains (mean p = 0.022, ES = 0.57) in the intervention period compared to the control period (mean p = 0.15, ES = 0.56). Irrespective of timing, significant strength improvements were seen immediately (10 weeks) and over 6 months for all children. This was also the case for improvements in the GAS (immediately: mean p = 0.007, ES = 4.17, 6 months: mean p = 0.029, ES = 0.99), and improvements in MV in all assessed muscles.
The simultaneous use of BoNT-A and strength training was successful in spasticity reduction, improving strength and achieving functional goals, over and above treatment with BoNT-A alone. Muscles targeted for BoNT-A injection should be included in strength training.
Cerebral Palsy• Botulinum toxin type-A (BoNT-A) and strength training are available interventions that, on their own have found success in managing spasticity and muscle weakness (both significant motor impairments), respectively in children with Cerebral Palsy (CP). • This study has demonstrated that the concurrent treatment of BoNT-A and strength training can achieve positive outcomes in terms of strength, spasticity and for the achievement of set functional goals. • The results of this study show that the improved muscle strength can be associated with hypertrophy, which could indicate the potential role of strength training in altering the rate of muscle growth, in an aim to improve the failure of muscle growth associated with CP. • Home based strength training, based on a child's individual goals is shown to be successful in improving strength and goal attainment for children with CP.
研究力量训练与 A 型肉毒毒素（BoNT-A）联合应用对脑瘫（CP）患儿肌肉力量和形态的影响。
本研究纳入了 15 名接受 BoNT-A 治疗的痉挛性双瘫 CP 患儿（GMFCS I-II 级，5-12 岁）。他们被随机分为两组，分别在 BoNT-A 治疗前或后接受 10 周的力量训练，评估时间为 6 个月。其中 8 名患儿还完成了一个对照期。改良 Ashworth 量表评估痉挛程度，目标达成量表（GAS）评估功能目标的实现情况，磁共振成像评估肌肉体积（MV），仪器测力计评估力量。
BoNT-A 注射后痉挛程度显著降低（p = 0.033）。与对照期相比，干预期患儿的等速肌力显著增加（平均 p = 0.022，ES = 0.57）（平均 p = 0.15，ES = 0.56）。无论时间如何，所有患儿的力量均在 10 周时立即得到改善，并在 6 个月时持续改善。GAS 也有类似的改善（立即：平均 p = 0.007，ES = 4.17，6 个月：平均 p = 0.029，ES = 0.99），所有评估肌肉的 MV 也有改善。
BoNT-A 联合力量训练可成功降低痉挛程度，提高力量和实现功能目标，优于单纯 BoNT-A 治疗。BoNT-A 注射的目标肌肉应包括在力量训练中。
脑瘫•肉毒毒素 A（BoNT-A）和力量训练是可用于治疗脑瘫的干预手段，单独使用时在降低痉挛程度和增强肌肉力量方面（均为脑瘫的重要运动障碍）分别取得了成功。•本研究表明，BoNT-A 和力量训练的联合治疗可在力量、痉挛程度和功能目标的实现方面取得积极的结果。•研究结果表明，肌肉力量的提高与肌肉肥大有关，这可能表明力量训练在改变与 CP 相关的肌肉生长速度方面具有潜在作用，以改善肌肉生长失败。•基于患儿个体目标的家庭力量训练已被证明可成功提高 CP 患儿的力量和目标实现。
