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Onabotulinum toxin-A (Botox) for spastic equinus in cerebral palsy: a prospective kinematic study

PURPOSE: Botulinum toxin-A (or Botox) is widely used for the management of equinus gait in children with cerebral palsy but few recent studies have included instrumented gait analysis. METHODS: This was a prospective cohort study. Gait analysis was performed four weeks before and four weeks after Bo...

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Autores principales: Hastings-Ison, T., Sangeux, M., Thomason, P., Rawicki, B., Fahey, M, Graham, H. K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The British Editorial Society of Bone & Joint Surgery 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090192/
https://www.ncbi.nlm.nih.gov/pubmed/30154931
http://dx.doi.org/10.1302/1863-2548.12.180044
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author Hastings-Ison, T.
Sangeux, M.
Thomason, P.
Rawicki, B.
Fahey, M
Graham, H. K.
author_facet Hastings-Ison, T.
Sangeux, M.
Thomason, P.
Rawicki, B.
Fahey, M
Graham, H. K.
author_sort Hastings-Ison, T.
collection PubMed
description PURPOSE: Botulinum toxin-A (or Botox) is widely used for the management of equinus gait in children with cerebral palsy but few recent studies have included instrumented gait analysis. METHODS: This was a prospective cohort study. Gait analysis was performed four weeks before and four weeks after Botulinum toxin-A injection for spastic equinus to detect the maximum effects on gait kinematics. Outcome measures included the Gait Profile Score (GPS), the Gait Variable Score (GVS) for the ankle, maximal ankle dorsiflexion and maximal knee extension at midstance. RESULTS: In all, 37 children participated (20 boys); mean age five years seven months (4 years 1 month to 8 years 2 months); 19 with unilateral and 18 bilateral involvement. At a mean four weeks post-injection, the GPS and ankle GVS were unchanged. However maximum ankle dorsiflexion increased for the whole group; median 7.7° (confidence interval (CI) 4° to 10.6°) to 11.5° (CI 7.7° to 12.9°), p = 0.02. Maximum midstance knee extension was unchanged for the whole group, but median knee flexion increased in children with bilateral involvement; 10.9° (CI 7.4° to 20.8°) to 16.5° (CI 8.4° to 19.7°), p = 0.58. CONCLUSION: Injections of the gastrocsoleus for spastic equinus did not result in objective improvements in overall gait. Improvements in ankle dorsiflexion for children with bilateral involvement may be offset by deterioration at the knee. LEVEL OF EVIDENCE: II - prospective cohort study, before and after intervention
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spelling pubmed-60901922018-08-28 Onabotulinum toxin-A (Botox) for spastic equinus in cerebral palsy: a prospective kinematic study Hastings-Ison, T. Sangeux, M. Thomason, P. Rawicki, B. Fahey, M Graham, H. K. J Child Orthop Original Clinical Article PURPOSE: Botulinum toxin-A (or Botox) is widely used for the management of equinus gait in children with cerebral palsy but few recent studies have included instrumented gait analysis. METHODS: This was a prospective cohort study. Gait analysis was performed four weeks before and four weeks after Botulinum toxin-A injection for spastic equinus to detect the maximum effects on gait kinematics. Outcome measures included the Gait Profile Score (GPS), the Gait Variable Score (GVS) for the ankle, maximal ankle dorsiflexion and maximal knee extension at midstance. RESULTS: In all, 37 children participated (20 boys); mean age five years seven months (4 years 1 month to 8 years 2 months); 19 with unilateral and 18 bilateral involvement. At a mean four weeks post-injection, the GPS and ankle GVS were unchanged. However maximum ankle dorsiflexion increased for the whole group; median 7.7° (confidence interval (CI) 4° to 10.6°) to 11.5° (CI 7.7° to 12.9°), p = 0.02. Maximum midstance knee extension was unchanged for the whole group, but median knee flexion increased in children with bilateral involvement; 10.9° (CI 7.4° to 20.8°) to 16.5° (CI 8.4° to 19.7°), p = 0.58. CONCLUSION: Injections of the gastrocsoleus for spastic equinus did not result in objective improvements in overall gait. Improvements in ankle dorsiflexion for children with bilateral involvement may be offset by deterioration at the knee. LEVEL OF EVIDENCE: II - prospective cohort study, before and after intervention The British Editorial Society of Bone & Joint Surgery 2018-08-01 /pmc/articles/PMC6090192/ /pubmed/30154931 http://dx.doi.org/10.1302/1863-2548.12.180044 Text en Copyright © 2018, The author(s) http://creativecommons.org/licenses/by-nc/4.0/ Open Access This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.
spellingShingle Original Clinical Article
Hastings-Ison, T.
Sangeux, M.
Thomason, P.
Rawicki, B.
Fahey, M
Graham, H. K.
Onabotulinum toxin-A (Botox) for spastic equinus in cerebral palsy: a prospective kinematic study
title Onabotulinum toxin-A (Botox) for spastic equinus in cerebral palsy: a prospective kinematic study
title_full Onabotulinum toxin-A (Botox) for spastic equinus in cerebral palsy: a prospective kinematic study
title_fullStr Onabotulinum toxin-A (Botox) for spastic equinus in cerebral palsy: a prospective kinematic study
title_full_unstemmed Onabotulinum toxin-A (Botox) for spastic equinus in cerebral palsy: a prospective kinematic study
title_short Onabotulinum toxin-A (Botox) for spastic equinus in cerebral palsy: a prospective kinematic study
title_sort onabotulinum toxin-a (botox) for spastic equinus in cerebral palsy: a prospective kinematic study
topic Original Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090192/
https://www.ncbi.nlm.nih.gov/pubmed/30154931
http://dx.doi.org/10.1302/1863-2548.12.180044
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