Advertisement

NeuroRX

, Volume 3, Issue 2, pp 217–224 | Cite as

Therapeutic interventions for tone abnormalities in cerebral palsy

  • Ann H. TiltonEmail author
Article

Summary

Cerebral palsy (CP) is a common cause of movement disorders in children. The upper motor neuron syndrome of CP leads to several types of muscle overactivity, including spasticity. Reduction of muscle overactivity may be an important treatment goal, to improve comfort, care, and active function and to prevent future musculoskeletal complications. After a comprehensive team evaluation, a treatment plan is generated. Treatments may include physical and occupational therapy, oral medications, botulinum toxin and/or phenol injections, intrathecal baclofen, selective dorsal rhizotomy, and orthopedic surgery. Successful and early prevention of contracture may reduce the need for later corrective surgery.

Key Words

Cerebral palsy spasticity botulinum toxin intrathecal baclofen selective dorsal rhizotomy orthopedic surgery 

References

  1. 1.
    Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Surveillance of Cerebral Palsy in Europe (SCPE).Dev Med Child Neurol 42: 816–824, 2000.CrossRefGoogle Scholar
  2. 2.
    Pharoah PO, Platt MJ, Cooke T. The changing epidemiology of cerebral palsy.Arch Dis Child Fetal Neonatal Ed 75: F169-F173, 1996.PubMedCrossRefGoogle Scholar
  3. 3.
    Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, Jacobsson B, Damiano D. Proposed definition and classification of cerebral palsy, April 2005.Dev Med Child Neurol 47: 571–576, 2005.PubMedCrossRefGoogle Scholar
  4. 4.
    Nelson KB, Ellenberg JH. Epidemiology of cerebral palsy.Adv Neurol 19: 421–435, 1978.PubMedGoogle Scholar
  5. 5.
    Sanger TD, Delgado MR, Gaebler-Spira D, Hallett M, Mink JW. Classification and definition of disorders causing hypertonia in childhood.Pediatrics 111: e89-e97, 2003.PubMedCrossRefGoogle Scholar
  6. 6.
    Mayer NH. Clinicophysiologic concepts of spasticity and motor dysfunction in adults with an upper motor neuron lesion. In: Spasticity: etiology, evaluation, management, and the role of botulinum toxin (Mayer NH, Simpson DM, eds), pp 1–15. New York: WE MOVE, 2002.Google Scholar
  7. 7.
    Russman BS, Tilton A, Gormley ME Jr. Cerebral palsy: a rational approach to a treatment protocol, and the role of botulinum toxin in treatment.Muscle Nerve Suppl 6: S181-S193, 1997.PubMedCrossRefGoogle Scholar
  8. 8.
    Lance JW. Symposium synopsis. In: Spasticity: disordered motor control (Feldman RG, Young RR, Koella WP, eds), pp 485–494. Chicago: Yearbook Medical, 1980.Google Scholar
  9. 9.
    Mayer NH, Herman RM. Phenomenology of muscle overactivity in the upper motor neuron syndrome. In: Muscle overactivity in the upper motor neuron syndrome: the role of oral medications, a focus on dantrolene sodium (Mayer NH, Pierson SH, eds), pp 1–25. New York: WE MOVE, 2004.Google Scholar
  10. 10.
    Bohannon RW, Smith MB. Interrater reliablity of a modified Ashworth scale of muscle spasticity.Phys Ther 67: 206–207, 1986.Google Scholar
  11. 11.
    Reimers J. Clinically based decision-making for surgery. In: The diplegic child evaluation and management (Sussman MD, ed), p 151. Rosemont, IL: American Academy of Orthopedic Surgeons, 1991.Google Scholar
  12. 12.
    Benda W, McGibbon NH, Grant KL. Improvements in muscle symmetry in children with cerebral palsy after equine-assisted therapy (hippotherapy).J Altern Complement Med 9: 817–825, 2003.PubMedCrossRefGoogle Scholar
  13. 13.
    Dali C, Hansen FJ, Pedersen SA, Skov L, Hilden J, Bjomskov I, Strandberg C, Jette C, Ulla H, Herbst G, Ulla L. Threshold electrical stimulation (TES) in ambulant children with CP: a randomized double-blind placebo-controlled clinical trial.Dev Med Child Neurol 44: 364–369, 2002.PubMedCrossRefGoogle Scholar
  14. 14.
    Hakkennes S, Keating JL. Constraint-induced movement therapy following stroke: a systematic review of randomised controlled trials.Aust J Physiother 51: 221–231, 2005.PubMedCrossRefGoogle Scholar
  15. 15.
    Taub E, Ramey SL, DeLuca S, Echols K. Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment.Pediatrics 113: 305–312, 2004.PubMedCrossRefGoogle Scholar
  16. 16.
    Damiano DL, Abel MF. Functional outcomes of strength training in spastic cerebral palsy.Arch Phys Med Rehabil 79: 119–125, 1998.PubMedCrossRefGoogle Scholar
  17. 17.
    Dodd KJ, Taylor NF, Graham HK. A randomized clinical trial of strength training in young people with cerebral palsy.Dev Med Child Neurol 45: 652–657, 2003.PubMedCrossRefGoogle Scholar
  18. 18.
    McBurney H, Taylor NF, Dodd KJ, Graham HK. A qualitative analysis of the benefits of strength training for young people with cerebral palsy.Dev Med Child Neurol 45: 658–663, 2003.PubMedCrossRefGoogle Scholar
  19. 19.
    Carlson WE, Vaughan CL, Damiano DL, Abel MF. Orthotic management of gait in spastic diplegia.Am J Phys Med Rehabil 76: 219–225, 1997.PubMedCrossRefGoogle Scholar
  20. 20.
    Wilson H, Haideri N, Song K, Telford D. Ankle-foot orthoses for preambulatory children with spastic diplegia.J Pediatr Orthop 17: 370–376, 1997.PubMedCrossRefGoogle Scholar
  21. 21.
    Corry IS, Cosgrove AP, Duffy CM, McNeill S, Taylor TC, Graham HK. Botulinum toxin A compared with stretching casts in the treatment of spastic equinus: a randomised prospective trial.J Pediatr Orthop 18: 304–311, 1998.PubMedCrossRefGoogle Scholar
  22. 22.
    Flett PJ, Stern LM, Waddy H, Connell TM, Seeger JD, Gibson SK. Botulinum toxin A versus fixed cast stretching for dynamic calf tightness in cerebral palsy.J Paediatr Child Health 35: 71–77. 1999.PubMedCrossRefGoogle Scholar
  23. 23.
    Bottos M, Benedetti MG, Salucci P, Gasparroni V, Giannini S. Botulinum toxin with and without casting in ambulant children with spastic diplegia: a clinical and functional assessment.Dev Med Child Neurol 45: 758–762, 2003.PubMedCrossRefGoogle Scholar
  24. 24.
    Kay RM, Rethlefsen SA, Fem-Buneo A, Wren TA, Skaggs DL. Botulinum toxin as an adjunct to serial casting treatment in children with cerebral palsy.J Bone Joint Surg Am 86A: 2377–2384, 2004.Google Scholar
  25. 25.
    Ackman JD, Russman BS, Thomas SS, Buckon CE, Sussman MD, Masso P, et al. Comparing botulinum toxin A with casting for treatment of dynamic equinus in children with cerebral palsy.Dev Med Child Neurol 47: 620–627, 2005.PubMedGoogle Scholar
  26. 26.
    Gracies JM, Nance P, Elovic E, McGuire J, Simpson DM. Traditional pharmacological treatments for spasticity. Part II: General and regional treatments.Muscle Nerve Suppl 6: S92-S120, 1997.PubMedCrossRefGoogle Scholar
  27. 27.
    Mathew A, Mathew MC, Thomas M, Antonisamy B. The efficacy of diazepam in enhancing motor function in children with spastic cerebral palsy.J Trop Pediatr 51: 109–113, 2005.PubMedCrossRefGoogle Scholar
  28. 28.
    Holt KS. The use of diazepam in childhood cerebral palsy: report of a small study including electromyographic observations.Ann Phys Med [Suppl]:16-24, 1964.Google Scholar
  29. 29.
    Engle HA. The effect of diazepam (Valium) in children with cerebral palsy: a double-blind study.Dev Med Child Neurol 8: 661–667, 1966.PubMedCrossRefGoogle Scholar
  30. 30.
    Dahlin M, Knutsson E, Nergardh A. Treatment of spasticity in children with low dose benzodiazepine.J Neurol Sci 117: 54–60. 1993.PubMedCrossRefGoogle Scholar
  31. 31.
    Milla PJ, Jackson AD. A controlled trial of baclofen in children with cerebral palsy.J Int Med Res 5: 398–404, 1977.PubMedGoogle Scholar
  32. 32.
    Brin IL, Kurenkov AL, Gotlib VI. [The use of sirdalud in cerebral palsy in children].Zh Nevrol Psikhiatr Im S S Korsakova 99: 30–33, 1999.PubMedGoogle Scholar
  33. 33.
    Joynt RL, Leonard JA Jr. Dantrolene sodium suspension in treatment of spastic cerebral palsy.Dev Med Child Neurol 22: 755–767, 1980.PubMedCrossRefGoogle Scholar
  34. 34.
    Nogen AG. Medical treatment for spasticity in children with cerebral palsy.Childs Brain 2: 304–308, 1976.PubMedGoogle Scholar
  35. 35.
    Chyatte SB, Birdsong JH, Bergman BA. The effects of dantrolene sodium on spasticity and motor performance in hemiplegia.South Med J 64: 180–185, 1971.PubMedCrossRefGoogle Scholar
  36. 36.
    Brin MF, Aoki KR. Botulinum toxin type A: pharmacology. In: Spasticity: etiology, evaluation, management, and the role of botulinum toxin (Mayer NH, Simpson DM, eds), pp 110–124. New York: WE MOVE, 2002.Google Scholar
  37. 37.
    WE MOVE. 2005 Management of spasticity with botulinum toxin type A (BOTOX®) [Online], 2005. Accessed January 4, 2006.Google Scholar
  38. 38.
    Speth LA, Leffers P, Janssen-Potten YJ, Vles JS. Botulinum toxin A and upper limb functional skills in hemiparetic cerebral palsy: a randomized trial in children receiving intensive therapy.Dev Med Child Neurol 47: 468–473, 2005.PubMedCrossRefGoogle Scholar
  39. 39.
    Steenbeek D, Meester-Delver A, Becher JG, Lankhorst GJ. The effect of botulinum toxin type A treatment of the lower extremity on the level of functional abilities in children with cerebral palsy: evaluation with goal attainment scaling.Clin Rehabil 19: 274–282. 2005.PubMedCrossRefGoogle Scholar
  40. 40.
    Wallen MA, O’Flaherty SJ, Waugh MC. Functional outcomes of intramuscular botulinum toxin type A in the upper limbs of children with cerebral palsy: a phase II trial.Arch Phys Med Rehabil 85: 192–200, 2004.PubMedCrossRefGoogle Scholar
  41. 41.
    Baker R, Jasinski M, Iag-Tymecka I, Michalowska-Mrozek J, Bonikowski M, Can- L, MacLean J, Lin JP, Lynch B, Theologis T, Wendorff J, Eunson P, Cosgrove A. Botulinum toxin treatment of spasticity in diplegic cerebral palsy: a randomized, double-blind, placebo-controlled, dose-ranging study.Dev Med Child Neurol 44: 666–675, 2002.PubMedCrossRefGoogle Scholar
  42. 42.
    Fehlings D, Rang M, Glazier J, Steele C. An evaluation of botulinum-A toxin injections to improve upper extremity function in children with hemiplegic cerebral palsy.J Pediatr 137: 331–337, 2000.PubMedCrossRefGoogle Scholar
  43. 43.
    Sutherland DH, Kaufman KR, Wyatt MP, Chambers HG, Mubarak SJ. Double-blind study of botulinum A toxin injections into the gastrocnemius muscle in patients with cerebral palsy.Gait Posture 10: 1–9, 1999.PubMedCrossRefGoogle Scholar
  44. 44.
    Cony IS, Cosgrove AP, Walsh EG, McClean D, Graham HK. Botulinum toxin A in the hemiplegic upper limb: a double-blind trial.Dev Med Child Neurol 39: 185–193, 1997.Google Scholar
  45. 45.
    Gracies JM, Elovic E, McGuire J, Simpson DM. Traditional pharmacologic treatments for spasticity. Part I: local treatments. In: Spasticity: etiology, evaluation, management, and the role of botulinum toxin (Mayer NH, Simpson DM, eds), pp 44–64. New York: WE MOVE, 2005.Google Scholar
  46. 46.
    Wong AM, Chen CL, Chen CP, Chou SW, Chung CY, Chen MJ. Clinical effects of botulinum toxin A and phenol block on gait in children with cerebral palsy.Am J Phys Med Rehabil 83: 284–291, 2004.PubMedCrossRefGoogle Scholar
  47. 47.
    Gooch JL, Patton CP. Combining botulinum toxin and phenol to manage spasticity in children.Arch Phys Med Rehabil 85: 1121–1124, 2004.PubMedCrossRefGoogle Scholar
  48. 48.
    Albright AL, Barron WB, Fasick MP, Polinko P, Janosky J. Continuous intrathecal baclofen infusion for spasticity of cerebral origin.JAMA 270: 2475–2477, 1993.PubMedCrossRefGoogle Scholar
  49. 49.
    Rawlins PK. Intrathecal baclofen therapy over 10 years.J Neurosci Nurs 36: 322–327, 2004.PubMedCrossRefGoogle Scholar
  50. 50.
    Gilmartin R, Bruce D, Stons BB, Abbott R, Krach L, Ward J, Bloom K, Brooks WH, Johnson DL, Madsen JR, McLaughlin JF, Nadell J. Intrathecal baclofen for management of spastic cerebral palsy: multicenter trial.J Child Neurol 15: 71–77, 2000.PubMedCrossRefGoogle Scholar
  51. 51.
    Van SP, Nuttin B, Lagae L, Schrijvers E, Borghgraef C, Feys P. Intrathecal baclofen for intractable cerebral spasticity: a prospective placebo-controlled, double-blind study.Neurosurgery 46: 603–609, 2000.CrossRefGoogle Scholar
  52. 52.
    Gerszten PC, Albright AL, Barry MJ. Effect on ambulation of continuous intrathecal baclofen infusion.Pediatr Neurosurg 27: 40–44, 1997.PubMedCrossRefGoogle Scholar
  53. 53.
    Gerszten PC, Albright AL, Johnstone GF. Intrathecal baclofen infusion and subsequent orthopedic surgery in patients with spastic cerebral palsy.J Neurosurg 88: 1009–1013, 1998.PubMedCrossRefGoogle Scholar
  54. 54.
    Murphy NA, Irwin MC, Hoff C. Intrathecal baclofen therapy in children with cerebral palsy: efficacy and complications.Arch Phys Med Rehabil 83: 1721–1725, 2002.PubMedCrossRefGoogle Scholar
  55. 55.
    Zuckerbraun NS, Ferson SS, Albright AL, Vogeley E. Intrathecal baclofen withdrawal: emergent recognition and management.Pediatr Emerg Care 20: 759–764, 2004.PubMedCrossRefGoogle Scholar
  56. 56.
    Darbari FP, Melvin JJ, Piatt JH Jr, Adirim TA, Kothare SV. Intrathecal baclofen overdose followed by withdrawal: clinical and EEG features.Pediatr Neurol 33: 373–377, 2005.PubMedCrossRefGoogle Scholar
  57. 57.
    Steinbok P. Outcomes after selective dorsal rhizotomy for spastic cerebral palsy.Childs Nerv Syst 17: 1–18, 2001.PubMedCrossRefGoogle Scholar
  58. 58.
    van Schie PE, Vermeiden RJ, van Ouwerkerk WJ, Kwakkel G, Becher JG. Selective dorsal rhizotomy in cerebral palsy to improve functional abilities: evaluation of criteria for selection.Childs Nerv Syst 21: 451–457, 2005.PubMedCrossRefGoogle Scholar
  59. 59.
    Galarza M, Fowler EG, Chipps L, Padden TM, Lazareff JA. Functional assessment of children with cerebral palsy following limited (L4-S1) selective posterior rhizotomy-a preliminary report.Acta Neurochir (Wien) 143: 865–872, 2001.CrossRefGoogle Scholar
  60. 60.
    Wright FV, Sheil EM, Drake JM, Wedge JH, Naumann S. Evaluation of selective dorsal rhizotomy for the reduction of spasticity in cerebral palsy: a randomized controlled trial.Dev Med Child Neurol 40: 239–247, 1998.PubMedCrossRefGoogle Scholar
  61. 61.
    Steinbok P, Reiner AM, Beauchamp R, Armstrong RW, Cochrane DD, Kestle J. A randomized clinical trial to compare selective posterior rhizotomy plus physiotherapy with physiotherapy alone in children with spastic diplegic cerebral palsy.Dev Med Child Neurol 39: 178–184, 1997.PubMedCrossRefGoogle Scholar
  62. 62.
    McLaughlin JF, Bjomson KF, Astley SJ, Graubert C, Hays RM, Roberts TS, Price R, Temkin N. Selective dorsal rhizotomy: efficacy and safety in an investigator-masked randomized clinical trial.Dev Med Child Neurol 40: 220–232, 1998.PubMedCrossRefGoogle Scholar
  63. 63.
    Engsberg JR, Ross SA, Park TS. Changes in ankle spasticity and strength following selective dorsal rhizotomy and physical therapy for spastic cerebral palsy.J Neurosurg 91: 727–732, 1999.PubMedCrossRefGoogle Scholar
  64. 64.
    Johnson MB, Goldstein L, Thomas SS, Piatt J, Aiona M, Sussman M. Spinal deformity after selective dorsal rhizotomy in ambulatory patients with cerebral palsy.J Pediatr Orthop 24: 529–536, 2004.PubMedCrossRefGoogle Scholar
  65. 65.
    Steinbok P, Hicdonmez T, Sawatzky B, Beauchamp R, Wickenheiser D. Spinal deformities after selective dorsal rhizotomy for spastic cerebral palsy.J Neurosurg 102: 363–373, 2005.PubMedCrossRefGoogle Scholar
  66. 66.
    Chicoine MR, Park TS, Kaufman BA. Selective dorsal rhizotomy and rates of orthopedic surgery in children with spastic cerebral palsy.J Neurosurg 86: 34–39, 1997.PubMedCrossRefGoogle Scholar
  67. 67.
    Hagglund G, Andersson S, Duppe H, Pedertsen HL, Nordmark E, Westbom L. Prevention of severe contractures might replace multilevel surgery in cerebral palsy: results of a population-based health care programme and new techniques to reduce spasticity.J Pediatr Orthop B 14: 269–273, 2005.PubMedCrossRefGoogle Scholar

Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2006

Authors and Affiliations

  1. 1.Louisiana State University Health and Sciences CenterNew Orleans
  2. 2.Children’s Hospital of New OrleansNew Orleans

Personalised recommendations