Affiliations: Department of Neurological Rehabilitation, Klinik
Berlin, Free University of Berlin, Germany | Social-Paediatric Centre, Campus Virchow, Humboldt
University of Berlin, Germany | Oskar-Helene Heim, Free University of Berlin,
Germany | National Rehabilitation Institute, Ljubljana,
Slovenia
Abstract: Purpose: The study investigated the effect of Botulinum toxin A on
the gait and lower limb muscle activity of ambulatory CP children. Methods: 19
spastic diplegic and 4 left hemiparetic CP children were injected with a mean
dose of 23.5 units of Botulinum toxin A/kg body weight into the gastrocnemius
and hamstring muscles. Muscle tone and gait analysis including the
kinesiological electromyogram of the shank and thigh muscles were assessed
before and four weeks after injection and compared with the help of a
multivariate analysis (p < 0.05). Results: Botulinum toxin A caused a
definite reduction of plantarflexor, knee and hip hypertonia in 21 children,
resulting in a more plantar grade and erect gait in 17 children four weeks
after injection. Gait analysis showed a statistically significant improvement
in peak ankle dorsi-flexion and knee extension during stance, and the length of
the force point of action under both feet increased. Electromyography revealed
sig-nificantly less co-contraction of the lower leg muscles, due to a more
phasic instead of a tonic activity of the tibialis anterior muscle, and an
improved activation pattern of the left rectus and biceps femoris muscles.
Conclusions: The present study demonstrated that the injection of Botulinum
toxin A resulted in a more mature muscle activation pattern of CP children.
Most of the children walked more plantigrade and erect, the functional gait
parameters, however, did not change.
