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Kinematic Aiming Task: Measuring Functional Changes in Hand and Arm Movements After Botulinum Toxin-A Injections in Children with Spastic Hemiplegia

Rameckers, Eugene A.A. PT, MRes; Speth, Lucianne A.W.M. MD; Duysens, Jacques PhD; Vles, J S. Hans PhD, MD; Smits-Engelsman, Bouwien C.M. PhD

American Journal of Physical Medicine & Rehabilitation: July 2007 - Volume 86 - Issue 7 - p 538-547
doi: 10.1097/PHM.0b013e31806dbc3c
Research Article: Cerebral Palsy

Rameckers EAA, Speth LAWM, Duysens J, Vles JSH, Smits-Engelsman BCM: Kinematic aiming task: measuring functional changes in hand and arm movements after botulinum toxin-a injections in children with spastic hemiplegia. Am J Phys Med Rehabil 2007;86:538–547.

Objective: To describe different aspects of a kinematic aiming task (KAT) as a quantitative way to assess changes in arm movements within 2 wks after botulinum toxin-A (BTX-A) injections in children with spastic hemiplegia.

Design: Intervention study randomized clinical trial; follow-up within 4 wks after baseline measurement.

Results: The KAT gave a high intraclass correlation on movement time, spread of end points (END), and index of performance effective (IP-E). After BTX-A, a significant increase of END and IP-E was shown if precision demand in the KAT was high, whereas the inverse occurred when speed was more important. These functional changes coincided with a significant decrease of the maximum voluntary contraction of the flexor muscles of the forearm. Muscle tone measured with the Ashworth scale did show a nonsignificant decrease of muscle tone, as did the stretch restricted angle and the active and passive ranges of motion of the elbow and wrist.

Conclusions: Muscle force decreased immediately after BTX-A, showing the direct effect of BTX-A. The KAT is an adequate, reproducible way to quantify functional changes after BTX-A in the upper limb. BTX-A has an inverse effect in the precision task when accuracy is important, and it has a positive effect when speed prevails.

From the Rehabilitation Foundation Limburg (SRL), Valkenburg, The Netherlands (EAAR, LAWMS); Department of Rehabilitation Medicine, Radboud University of Nijmegen, The Netherlands (EAAR, JD, BCMS-E); Academic Hospital Maastricht (azM), The Netherlands (EAAR, LAWMS, JSHV); Avans+, University for Professionals, Breda, The Netherlands (EAAR, BCMS-E); Motor Control Lab, Department of Kinesiology, K.U. Leuven, Belgium (BCMS-E); and Sint Maartenskliniek-Research, Development and Education, Nijmegen, The Netherlands (EAAR, JD, BCMS-E).

All correspondence and requests for reprints should be addressed to E. Rameckers, Rehabilitation Foundation Limburg (SRL)-Radboud University, Department of Rehabilitation Medicine, Reinier Postlaan 4, Nymegen, NL 6525GC The Netherlands.

© 2007 Lippincott Williams & Wilkins, Inc.