Does combining physiotherapy with Botulinum toxin type A injections improve the management of children with spastic cerebral palsy?

Flemban, Abeer (2008) Does combining physiotherapy with Botulinum toxin type A injections improve the management of children with spastic cerebral palsy? PhD thesis, University of Glasgow.

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Cerebral palsy (CP) affects around every one in 500 children born. It isn’t a particular illness or disease, but an umbrella term used to describe a physical condition that affects movement as a result of injury to the brain. There are several types of CP, the main ones being spastic, athetoid and ataxic. Despite medical advances, there is no cure for CP but there are ranges of treatments from drugs to Botulinum toxin type A injections, massage therapy to surgery. The aim of this study is to look at two of these treatments, namely Botulinum toxin type A injections and physiotherapy to treat spastic CP.
Botulinum toxin is widely used to reduce muscle tone in the treatment of spasticity in children with cerebral palsy. The aim of the study is to compare the effects treatment with Botulinum toxin type A and Botulinum toxin type A with additional physical therapy in the management of a group of children with cerebral palsy.

Experiments were done at The Prince Sultan Hospital and Al-Hada Armed Forces Hospital in Saudi Arabia. The local Ethics Committee approved the protocol. 47 children were recruited. All had cerebral palsy, diplegia, spasticity of the ankle planter flexors and significant gait abnormalities due to dynamic equinus foot deformity. They were divided into two groups. Both groups had their Gross Motor Function assessed one week before injection and at 4 and 6 weeks after injection. Additional measurements of range of movement and stiffness at the ankle and soleus electromyograms were recorded
The soleus EMG was silent during ankle dorsiflexion in 20 children four weeks after injection of Botox. The EMG had returned six weeks after injection in every child. The Gross Motor Function Measurements were not significantly different in the two groups before the injection (p=0.23). The measurements improved significantly over the next six weeks in both groups (p<0.001). The magnitude of the improvement was greater in the group, which received Botulinum toxin type A and physical therapy (means 57.2 + 8.90 before, 64.9 + 9.78 after. Mean + SD) than in the group which received Botulinum toxin type A alone (59.5 + 11.0 before, 62.4 + 11.3 after Mean + SD).


1. . The Treatment allocation provided groups, which were comparable pre-treatment in terms of baseline GMFM.

2. . Both treatments showed evidence of improvement in GMFM over the period of the study and particularly at 52 weeks.

3. . Treatment 2 showed a significant average advantage in GMFM over Treatment 1 at all times in the study.

4. . This advantage in average GMFM increased from 4 through to 52 weeks with a clear and significant difference between 4 and 52 weeks.

5. . This average advantage appeared to increase the higher the child’s baseline GMFM.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: Cerebral palsy (CP), Botulinum toxin type A, Gross Motor Function Measurements (GMFM), Physical Therapy (PT)
Subjects: R Medicine > R Medicine (General)
R Medicine > RJ Pediatrics
Colleges/Schools: College of Medical Veterinary and Life Sciences > Institute of Neuroscience and Psychology
Supervisor's Name: Baxendale, Dr. Ron
Date of Award: 2008
Depositing User: Dr Abeer Flemban
Unique ID: glathesis:2008-494
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 20 Apr 2009
Last Modified: 10 Dec 2012 13:19

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