Injection of botulinum A toxin into the gastrocnemius muscle of patients with cerebral palsy: A 3-dimensional motion analysis study

David H. Sutherland, Kenton R Kaufman, Marilynn P. Wyatt, Henry G. Chambers

Research output: Contribution to journalArticle

77 Citations (Scopus)

Abstract

Botulinum A toxin (BOTOX®) was injected into the gastrocnemius muscle of 26 cerebral palsy subjects with equinus gait. All subjects were equinus walkers without fixed contracture of the triceps-surae muscle. Injections were performed at 3 month intervals, if needed, as determined by the treating clinician. There were 14 subjects with spastic hemiplegia, 11 subjects with spastic diplegia and 1 subject with spastic quadriplegia. In the case of those subjects with bilateral equinus gait the dose was divided and given into both the right and left gastrocnemius muscle. Gait analysis data was collected prior to the first injection and subsequently at 3 month intervals for 1 year. Kinematic and electromyographic data was obtained. This data was analyzed to provide objective information about the outcome of treatment. Four subjects moved away and were lost to follow-up. Seven subjects left the study to have surgery. The data collected revealed statistically significant improvements in dynamic ankle dorsiflexion in both stance and swing phases, stride length, and electromyography of the tibialis anterior. There were no complications. While the results of this study are promising, additional prospective studies are needed to determine the feasibility of preventing muscle contractures over a longer time period. Furthermore, there is a need for inclusion of other muscles in future research. Future research should also compare BOTOX® treatment with alternative methods of dealing with muscle spasticity such as: casting, orthotic devices, physical therapy, selective dorsal rhizotomy, and surgical lengthening.

Original languageEnglish (US)
Pages (from-to)269-279
Number of pages11
JournalGait and Posture
Volume4
Issue number4
DOIs
StatePublished - Oct 1996
Externally publishedYes

Fingerprint

Type A Botulinum Toxins
Cerebral Palsy
Gait
Skeletal Muscle
Contracture
Muscles
Injections
Walkers
Rhizotomy
Orthotic Devices
Quadriplegia
Hemiplegia
Muscle Spasticity
Lost to Follow-Up
Electromyography
Biomechanical Phenomena
Ankle
Prospective Studies
Therapeutics

Keywords

  • Botulinum A toxin
  • Cerebral palsy
  • Equinus
  • Gait analysis
  • Gastrocnemius

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Injection of botulinum A toxin into the gastrocnemius muscle of patients with cerebral palsy : A 3-dimensional motion analysis study. / Sutherland, David H.; Kaufman, Kenton R; Wyatt, Marilynn P.; Chambers, Henry G.

In: Gait and Posture, Vol. 4, No. 4, 10.1996, p. 269-279.

Research output: Contribution to journalArticle

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abstract = "Botulinum A toxin (BOTOX{\circledR}) was injected into the gastrocnemius muscle of 26 cerebral palsy subjects with equinus gait. All subjects were equinus walkers without fixed contracture of the triceps-surae muscle. Injections were performed at 3 month intervals, if needed, as determined by the treating clinician. There were 14 subjects with spastic hemiplegia, 11 subjects with spastic diplegia and 1 subject with spastic quadriplegia. In the case of those subjects with bilateral equinus gait the dose was divided and given into both the right and left gastrocnemius muscle. Gait analysis data was collected prior to the first injection and subsequently at 3 month intervals for 1 year. Kinematic and electromyographic data was obtained. This data was analyzed to provide objective information about the outcome of treatment. Four subjects moved away and were lost to follow-up. Seven subjects left the study to have surgery. The data collected revealed statistically significant improvements in dynamic ankle dorsiflexion in both stance and swing phases, stride length, and electromyography of the tibialis anterior. There were no complications. While the results of this study are promising, additional prospective studies are needed to determine the feasibility of preventing muscle contractures over a longer time period. Furthermore, there is a need for inclusion of other muscles in future research. Future research should also compare BOTOX{\circledR} treatment with alternative methods of dealing with muscle spasticity such as: casting, orthotic devices, physical therapy, selective dorsal rhizotomy, and surgical lengthening.",
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