Effects of Electrical Stimulation and Botulinum Toxin on Motor Function in

1. Effects of Electrical Stimulation and Botulinum Toxin on Motor Function in Children with Spastic Diplegia Kevin Mooney SPT & Conner Zuber SPT Background Research Conclusion • Several studies have indicated benefits of using electrical stimulation on the lower limbs and trunk including: • Reduced spasticity in hip adductors to normalize and improve gait parameters (1) • Improved GMFM sitting score and sitting balance (2) • Decrease in Cobb and kyphotic angles to improve posture (2) • Several studies have shown the benefits of botulinum toxin injections in the lower limbs for GMFCS Grades I - III: • Goal is to predominantly improve ambulation (4) • Improved Gross Motor Function Measure total scores (3) • Improved ambulatory status and sagittal-plane kinematics (3) • Maintained functional motor/ambulatory gains at six months post injection (5) • All studies have shown these interventions are most effective when combined with conventional physical therapy.(1,2,3,4,5) • Both interventions can be utilized for pain management. (4) • Our findings suggest that using these interventions combined with conventional PT significantly enhances motor function. • These improvements in motor function lead to: • Increased postural control • Improved ambulatory pattern • Improved quality of life • Increased independence with ADLs • Children with lower extremity involvement and GMFCS Grades I-III seem to benefit the most from these interventions. (1,4) • Further research should be conducted on combining electrical stimulation with botulinum toxin. • Spastic Diplegia is a form of Cerebral Palsy that is a chronic neuromuscular disease of low tone and spasticity. • Impairments: • Spastic hip adductors • Muscle imbalances • Limited joint ROM • Weak trunk control • Poor coordination of flexors and extensors in lower limbs. • Due to these impairments, a considerable amount of money is spent on treatment and improving quality of life, increasing motor function, and promoting independence in ADLs. References Electrical Stimulation & Botulinum Toxin 1.AlAbdulwahab S, Al-Gabbani M. Transcutaneous electrical nerve stimulation of hip adductors improves gait parameters of children with spastic diplegic cerebral palsy. Neurorehabilitation [serial online]. February 2010;26(2):115-122. Available from: CINAHL with Full Text, Ipswich, MA. Accessed November 15, 2013. 2.Karabay İ, Dogan A, Arslan M, Dost G, Ozgirgin N. Effects of functional electrical stimulation on trunk control in children with diplegic cerebral palsy. Disability & Rehabilitation [serial online]. June 15, 2012;34(11):965-970. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed November 15, 2013. 3.Nolan K, Cole L, Liptak G. Use of Botulinum Toxin Type A in Children With Cerebral Palsy. Physical Therapy [serial online]. April 2006;86(4):573-584. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed November 15, 2013 4.Pin T, Elmasry J, Lewis J. Efficacy of botulinum toxin A in children with cerebral palsy in Gross Motor Function Classification System levels IV and V: a systematic review. Developmental Medicine & Child Neurology [serial online]. April 2013;55(4):304-313. Available from: CINAHL, Ipswich, MA. Accessed November 15, 2013. 5.Unlu E, Cevikol A, Bal B, Gonen E, Celik O, Kose G. Multilevel botulinum toxin type a as a treatment for spasticity in children with cerebral palsy: a retrospective study. Clinics (São Paulo, Brazil) [serial online]. June 2010;65(6):613-619. Available from: MEDLINE, Ipswich, MA. Accessed November 15, 2013. • Electrical stimulation and botulinum toxin can be used clinically to treat children with spastic diplegia and their impairments. • Electrical stimulation has shown to be well tolerated in children and when applied to the lower extremities can improve: • Lower extremity function • Gait speed • Lower extremity ROM (1) • Botulinum toxin is a neurotoxin which inhibits the pre-synaptic release of acetylcholine from nerve terminals which produces muscle weakness/paralysis. • Lasts approximately 3 months • Decreases spasticity • Improves lower limb kinematics (4) http://www.physiofunction.co.uk/Uploads/Image/Conditions/CP3new.jpg http://blog.daum.net/kbrass/15653106