FAMILY-CENTRED, GOAL-DIRECTED MULTIDISCIPLINARY APPROACH FOR LOWER EXTREMITY BOTULINUM TOXIN WITH PHYSICAL THERAPY AND REHABILITATION IN CEREBRAL PALSY

Year 2020, Volume: 31 Issue: 1, 1 - 10, 13.04.2020

Kübra Seyhan , Mintaze Kerem Günel , Ece Ünlü Akyüz

https://doi.org/10.21653/tjpr.546325

Cited By: 1

Abstract

Purpose: This study aimed to investigate lower extremity botulinum toxin (BT) and physical therapy
and rehabilitation (PTR) application scoping “family-centered, goal-directed multidisciplinary approach
(FGMA)” in the children with cerebral palsy (CP) and to assess the satisfaction of parents and children
from this approach.
Methods: A physician and physiotherapist evaluated 30 children (age=6.33±2.38 years) with ambulatory
CP and their parents using the FGMA. Gross Motor Function Classification System (GMFCS), Manual
Ability Classification System (MACS), and Communication Function Classification System (CFCS)
were used to define the functionality of children. Selectivity was assessed using the Selective Control
Assessment of the Lower Extremity (SCALE). Walking was evaluated using the Observational Gait Scale
(OGS) and the Gillette Functional Assessment Questionnaire (FAQ). Satisfaction levels marked on the
Visual Analogue Scale.
Results: Nineteen (63%) children were GMFCS level III, 16 (53%) children were MACS level I, 19 (63.33%)
children were CFCS level I. Half of children had visual problems. While the most preferred muscles were
hamstring and gastrocnemius for BT, the most common device was ankle-foot orthosis. The median score
of SCALE, OGS, and FAQ, and the satisfaction of parents and children were 8 (4-17), 12 (2-24), 2 (1-10),
9 (7-10), and 7 (6-10) points, respectively. The satisfaction level of parents with the new approach was
higher than the previous traditional approach (p<0.001).
Conclusions: Both the parents and children may be satisfied with the FGMA for BT with the PTR program.
Clinicians should take into account lower extremity selectivity, walking performance, and satisfaction
levels as much as muscle tone or range of motion.
Key Words: Botulinum Toxin; Cerebral Palsy; Parent; Physical Therapy.

Keywords

Botulinum Toxin, Cerebral palsy, Parent, Physiotherapy

References

• 1. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol. 2007;109(suppl 109):8-14.
• 2. Sankar C, Mundkur N. Cerebral palsy-definition, classification, etiology and early diagnosis. Indian J Pediatr. 2005;72(10):865-8.
• 3. Kahraman A, Seyhan K, Değer Ü, Kutlutürk S, Mutlu A. Should botulinum toxin A injections be repeated in children with cerebral palsy? A systematic review. Dev Med Child Neurol. 2016;58(9):910-7.
• 4. Boyd R, Graham HK, editors. Botulinum toxin A in the management of children with cerebral palsy: indications and outcome. Eur J Neurol; 1997: Lippincott Williams & Wilkins.
• 5. Heinen F, Desloovere K, Schroeder AS, Berweck S, Borggraefe I, van Campenhout A, et al. The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol. 2010;14(1):45-66.
• 6. Molenaers G, Van Campenhout A, Fagard K, De Cat J, Desloovere K. The use of botulinum toxin A in children with cerebral palsy, with a focus on the lower limb. J Child Orthop. 2010;4(3):183-95.
• 7. Scholtes VA, Dallmeijer AJ, Knol DL, Speth LA, Maathuis CG, Jongerius PH, et al. The combined effect of lower-limb multilevel botulinum toxin type A and comprehensive rehabilitation on mobility in children with cerebral palsy: a randomized clinical trial. Arch Phys Med Rehabil. 2006;87(12):1551-8.
• 8. Schasfoort F, Dallmeijer A, Pangalila R, Catsman C, Stam H, Becher J, et al. Value of botulinum toxin injections preceding a comprehensive rehabilitation period for children with spastic cerebral palsy: A cost-effectiveness study.J Rehabil Med. 2018;50(1):22-9.
• 9. Degelaen M, De Borre L, Kerckhofs E, De Meirleir L, Buyl R, Cheron G, et al. Influence of botulinum toxin therapy on postural control and lower limb intersegmental coordination in children with spastic cerebral palsy. Toxins. 2013;5(1):93-105.
• 10. Strobl W, Theologis T, Brunner R, Kocer S, Viehweger E, Pascual-Pascual I, et al. Best clinical practice in botulinum toxin treatment for children with cerebral palsy. Toxins (Basel). 2015;7(5):1629-48.
• 11. Lowing K, Thews K, Haglund-Akerlind Y, Gutierrez-Farewik EM. Effects of Botulinum Toxin-A and Goal-Directed Physiotherapy in Children with Cerebral Palsy GMFCS Levels I & II. Phys Occup Ther Pediatr. 2017;37(3):268-82.
• 12. El O, Baydar M, Berk H, Peker O, Kosay C, Demiral Y. Interobserver reliability of the Turkish version of the expanded and revised gross motor function classification system. Disabil Rehabil. 2012;34(12):1030-3.
• 13. Eliasson A-C, Krumlinde-Sundholm L, Rösblad B, Beckung E, Arner M, Öhrvall A-M, et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol. 2006;48(7):549-54.
• 14. Mutlu A, Kara OK, Livanelioglu A, Karahan S, Alkan H, Yardimci BN, et al. Agreement between parents and clinicians on the communication function levels and relationship of classification systems of children with cerebral palsy. Disabil Health J. 2018;11(2):281-6.
• 15. Numanoglu A, Gunel MK. Intraobserver reliability of modified Ashworth scale and modified Tardieu scale in the assessment of spasticity in children with cerebral palsy. Acta Orthop Traumato Turc. 2012;46(3):196-200.
• 16. Yam WKL, Leung MSM. Interrater reliability of Modified Ashworth Scale and Modified Tardieu Scale in children with spastic cerebral palsy. J Child Neurol. 2006;21(12):1031-5.
• 17. Fowler EG, Staudt LA, Greenberg MB, Oppenheim WL. Selective Control Assessment of the Lower Extremity (SCALE): development, validation, and interrater reliability of a clinical tool for patients with cerebral palsy. Dev Med Child Neurol. 2009;51(8):607-14.
• 18. Wren TA, Rethlefsen SA, Healy BS, Do KP, Dennis SW, Kay RM. Reliability and validity of visual assessments of gait using a modified physician rating scale for crouch and foot contact. J Pediatr Orthop. 2005;25(5):646-50.
• 19. Seyhan K, Çankaya Ö, Şimşek TT, Günel MK. Serebral palsili çocuklarda Gillette fonksiyonel yürüme değerlendirme anketinin gözlemci içi güvenirlik ve geçerliğinin araştırılması. Turk J Physiother Rehabil.29(3):73-8.
• 20. Vles GF, de Louw AJ, Speth LA, van Rhijn LW, Janssen-Potten YJ, Hendriksen JG, et al. Visual Analogue Scale to score the effects of Botulinum Toxin A treatment in children with cerebral palsy in daily clinical practice. Eur J Paediatr Neurol. 2008;12(3):231-8.
• 21. Pope C, Ziebland S, Mays N. Qualitative research in health care: analysing qualitative data. BMJ: Br Med J. 2000;320(7227):114.
• 22. Odding E, Roebroeck ME, Stam HJ. The epidemiology of cerebral palsy: incidence, impairments and risk factors. Disabil Rehabil. 2006;28(4):183-91.
• 23. Porro G, Van der Linden D, Van Nieuwenhuizen O, Wittebol-Post D. Role of visual dysfunction in postural control in children with cerebral palsy. Neural Plast. 2005;12(2-3):205-10.
• 24. Pharoah P, Cooke T, Johnson M, King R, Mutch L. Epidemiology of cerebral palsy in England and Scotland, 1984–9. Archives of Disease in Childhood-Fetal and Neonatal Edition. 1998;79(1):F21-F5.
• 25. Himmelmann K, Beckung E, Hagberg G, Uvebrant P. Gross and fine motor function and accompanying impairments in cerebral palsy. Dev Med Child Neurol. 2006;48(6):417-23.
• 26. Hazneci B, Tan AK, Guncikan MN, Dincer K, Kalyon TA. Comparison of the efficacies of botulinum toxin A and Johnstone pressure splints against hip adductor spasticity among patients with cerebral palsy: a randomized trial. Mil Med. 2006;171(7):653-6.
• 27. El O, Peker O, Kosay C, Iyilikci L, Bozan O, Berk H. Botulinum toxin A injection for spasticity in diplegic-type cerebral palsy. Child Neurol. 2006;21(12):1009-12.
• 28. Chaléat-Valayer E, Parratte B, Colin C, Denis A, Oudin S, Berard C, et al. A French observational study of botulinum toxin use in the management of children with cerebral palsy: BOTULOSCOPE. Eur J Paediatr Neurol. 2011;15(5):439-48.
• 29. 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. 2010;65(6):613-9.
• 30. McGinley JL, Baker R, Wolfe R, Morris ME. The reliability of three-dimensional kinematic gait measurements: a systematic review. Gait Posture. 2009;29(3):360-9.
• 31. Wren TA, Gorton III GE, Ounpuu S, Tucker CA. Efficacy of clinical gait analysis: a systematic review. Gait Posture. 2011;34(2):149-53.
• 32. Rathinam C, Bateman A, Peirson J, Skinner J. Observational gait assessment tools in paediatrics–a systematic review. Gait Posture. 2014;40(2):279-85.
• 33. Franzén M, Hägglund G, Alriksson-Schmidt A. Treatment with Botulinum toxin A in a total population of children with cerebral palsy-a retrospective cohort registry study. BMC Musculoskeletal Disord. 2017;18(1):520.
• 34. Löwing K, Bexelius A, Brogren Carlberg E. Activity focused and goal directed therapy for children with cerebral palsy–do goals make a difference? Disabil Rehabil. 2009;31(22):1808-16.
• 35. King S, Teplicky R, King G, Rosenbaum P, editors. Family-centered service for children with cerebral palsy and their families: a review of the literature. Semin Pediatr Neurol; 2004: Elsevier.
• 36. Law M, Darrah J, Pollock N, King G, Rosenbaum P, Russell D, et al. Family-centred functional therapy for children with cerebral palsy: an emerging practice model. Phys Occup Ther Pediatr. 1998;18(1):83-102.