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Botulinum Toxin A Injection into Calf Muscles for Treatment of Spastic Equinus in Cerebral Palsy: A Controlled Trial Comparing Sonography and Electric Stimulation-Guided Injection Techniques: A Preliminary Report

Kwon, Jeong-Yi MD, PhD; Hwang, Ji Hye MD, PhD; Kim, Joon-Sung MD, PhD

American Journal of Physical Medicine & Rehabilitation:
doi: 10.1097/PHM.0b013e3181ca24ac
Original Research Article: Spasticity
Abstract

Kwon J-Y, Hwang JH, Kim J-S: Botulinum toxin A injection into calf muscles for treatment of spastic equinus in cerebral palsy: A controlled trial comparing sonography and electric stimulation-guided injection techniques: A preliminary report.

Objective: To compare the clinical outcomes of two different injection techniques, one guided by electric stimulation and the other by sonography, for botulinum toxin A injection into calf muscles for the treatment of spastic equinus in children with cerebral palsy.

Design: Thirty-two children with cerebral palsy with spastic equinus gait were enrolled in separate categories according to their level under the Gross Motor Function Classification System and divided into two groups with alternate allocation: sonography-guided group and electric stimulation-guided group. Equal amounts of botulinum toxin A were injected into the gastrocnemius at four to six points in 30 children with cerebral palsy. The injection was guided by electric stimulation in 14 and by ultrasonography in 16 children. Modified Ashworth Scale, Modified Tardieu Scale, Selective Motor Control, and Physician's Rating Scale were measured at baseline, 1 mo, and 3 mos posttreatment.

Results: Subscales of the Physician's Rating Scale (gait pattern and hindfoot position-maximum foot/floor contact during stance) significantly improved in the sonography-guided group. No statistical differences were noted in Modified Ashworth Scale, Modified Tardieu Scale, and Selective Motor Control.

Conclusions: Visual feedback by ultrasonography could improve the accuracy of selective neuromuscular blocking of the gastrocnemius.

Author Information

From the Department of Physical and Rehabilitation Medicine (J-YK, JHH), Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong, Kangnam-gu, Seoul, Republic of Korea; and Department of Rehabilitation Medicine (J-SK), St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

All correspondence and requests for reprints should be addressed to Jeong-Yi Kwon, MD, PhD, Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Kangnam-gu, Seoul, Republic of Korea 135-710.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

© 2010 Lippincott Williams & Wilkins, Inc.