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Rehabilitation Practice and Science

Translated Title

結合A型肉毒桿菌毒素注射與改良式侷限誘發動作治療於痙攣型半側偏癱腦性麻痺台灣兒童之療效：病例報告

Abstract

Hypertonia interferes with selective motor control and performance of activities in children with spastic cerebral palsy. At present, most therapists use traditional therapeutic techniques such as neurodevelopmental treatment or other approaches to handle the problems posed by cerebral palsy but the results are not very good. Many studies had shown that botulinum toxin type A (BTX-A) injection can control abnormal muscle tone effectively without major side effects. Constraint-induced movement therapy (CIMT) includes constraint of the sound side upper limb and intensive therapy of the affected limb. In order to reduce spasticity and enhance the use of the affected limb simultaneously, we combined these two therapies and investigated treatment feasibility.Our patient was a 9 year-old boy with spastic hemiplegic cerebral palsy. He received BTX-A injection once and modified CIMT in left upper limb for two months. Outcome measurements were assessed before injection, and one month, two months, and four months after injection by the same investigator. The evaluation tools included the Modified Ashworth Scale (MAS), the Pediatric Evaluation of Disability Inventory (PEDI) self care domain: functional skills and caregiver assistance, the Peabody Developmental Motor Scale-2 (PDMS-2) fine motor quotient: grasping and visual-motor integration, the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) subtest 8, and the Upper Limb Physician's Rating Scale (ULPRS) modified version. The results show that MAS scores decreased at one and two months but increased at four months after BTX-A injection. All other outcome measurement scores increased at one month, two months and four months. This means that the treatment effects can be maintained for at least two months after cessation of modified CIMT. We found that combining BTX-A injection and modified CIMT can improve function of the upper extremity. In the future, we plan to enroll more subjects to investigate if this technique is useful for children with spastic hemiplegic cerebral palsy.

Language

Traditional Chinese

First Page

119

Last Page

125

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