Comparative assessment of therapeutic response to physiotherapy with or without botulinum toxin injection using diffusion tensor tractography and clinical scores in term diplegic cerebral palsy children

@article{Chaturvedi2013ComparativeAO,
  title={Comparative assessment of therapeutic response to physiotherapy with or without botulinum toxin injection using diffusion tensor tractography and clinical scores in term diplegic cerebral palsy children},
  author={Saurabh Chaturvedi and Yogita Rai and Ankita Chourasia and Puneet Goel and Vimal Kumar Paliwal and Ravindra Kumar Garg and Ram Kishore Singh Rathore and Chandra Mani Pandey and Rakesh K. Gupta},
  journal={Brain and Development},
  year={2013},
  volume={35},
  pages={647-653}
}
The Effect of Botulinum Toxin Injections on Gross Motor Function for Lower Limb Spasticity in Children with Cerebral Palsy
TLDR
Younger age at injection and distal injection type were associated with larger improvements on the GMFM-88 at both short- and midterm follow-up, which was significantly related with greater gain in gross motor function.
The efficacy of botulinum toxin A lower limb injections in addition to physiotherapy approaches in children with cerebral palsy: A systematic review.
TLDR
The use of BTX-A injections in addition to physiotherapy approaches seems to have positive effect on spasticity and ROM, but the question of whether the treatment of BTx-A plus physiotherapy has a greater improvement on functional capacity, such as gross motor function or gait parameter than only physiotherapy treatments, was inconclusive.
Changes in diffusion tensor tractographic findings associated with constraint-induced movement therapy in young children with cerebral palsy
GRIN: “GRoup versus INdividual physiotherapy following lower limb intra-muscular Botulinum Toxin-A injections for ambulant children with cerebral palsy: an assessor-masked randomised comparison trial”: study protocol
TLDR
This study aims to compare individual to group-based physiotherapy following intramuscular Botulinum Toxin-A injections to the lower limbs for ambulant children with cerebral palsy aged four to fourteen years.
Botulinum toxin type A in the treatment of lower limb spasticity in children with cerebral palsy.
TLDR
BoNT-A improves ankle range of motion, satisfaction, and ankle plantarflexors spasticity at one or more time points (very low-quality evidence) and is moderately effective at improving function at short-term (SMD 0.59; I2 = 95%; very low- quality evidence).
How Does Botulinum Toxin Injection and Physiotherapy Complement Each Other in Cerebral Palsy
TLDR
BoNT, which is a neurotoxin obtained from Clostridium botulinum bacteria, is frequently used in children with CP to decrease muscle tone for a certain period in the selected muscles, prevent contractures, postpone surgery and decrease frequency of surgeries.
Cerebral Blood Flow and DTI metrics changes in children with cerebral palsy following therapy
TLDR
CBF values are high in CP children as compared to controls and show alteration following therapy even when the DTI metrics remain unchanged, and arterial spin labeling (ASL) may be added to the advanced imaging protocol for studying brain plasticity in such children in future.
Intrinsic properties and functional changes in spastic muscle after application of BTX-A in children with cerebral palsy: Systematic review
TLDR
BTX-A application demonstrated no changes in the passive stiffness of spastic muscle and showed methodological quality limitations that restrict the interpretation of the results for the entire CP population, which justifies the need for further randomized controlled trials.
Botulinum Toxin as a Stand-Alone Treatment for Muscle Spasticity: Review of the Evidence
TLDR
It is suggested that the use of botulinum toxin as a stand-alone treatment of spasticity is justifiable, especially when other therapies are not immediately available for use in combination with the toxin.
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References

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Botulinum toxin A and upper limb functional skills in hemiparetic cerebral palsy: a randomized trial in children receiving intensive therapy
TLDR
Intramuscular BTX-A added to an intensive therapy programme reduces impairment for at least 9 months; the effect on activity level is still uncertain.
The effect of different physiotherapy interventions in post-BTX-A treatment of children with cerebral palsy.
Correlation of quantitative sensorimotor tractography with clinical grade of cerebral palsy
TLDR
White matter tracts from both the somatosensory and the motor cortex play an important role in the pathophysiology of motor disability in patients with CP, and significant inverse correlation between clinical grade and fractional anisotropy was observed.
The effect of botulinum toxin type A on the functional ability of the child with spastic hemiplegia a randomized controlled trial
TLDR
The effect of this treatment on functional ability, as measured by the Gross Motor Function Measure (GMFM), in children with spastic hemiplegic cerebral palsy was measured and changes in GMFM correlated with changes in technical outcomes at 3 months, suggesting a causal relationship.
Treatment-induced plasticity in cerebral palsy: a diffusion tensor imaging study.
[Botulinum toxin A--effect on spasticity].
TLDR
It seemed that patients with some preserved motor control in the spastic limb could use it to learn more appropriate movement strategies, and doctors and physiotherapists work together to identify muscle groups that need to be targeted for injection and evaluate consequences of the treatment.
Effect of multilevel botulinum toxin a and comprehensive rehabilitation on gait in cerebral palsy.
Children undergoing treatment with botulinum toxin: The role of the physical therapist
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    Muscle & nerve. Supplement
  • 1997
TLDR
For the cerebral palsy patient undergoing BTX therapy, the physical therapist is involved in each step of treatment, from patient selection to outcome assessment, and the weakness brought on by BTX treatment provides important opportunities for functional retraining.
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