Functional outcomes of botulinum neurotoxin-A injection followed by reciprocal electrical stimulation in children with cerebral palsy: A randomized controlled trial

Article type: Research Article

Authors: Elnaggar, Ragab K.^{a; b; *} | Alqahtani, Bader A.^a | Elbanna, Mohammed F.^{b; c}

Affiliations: [a] Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia | [b] Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt | [c] Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia

Correspondence: [*] Corresponding author: Ragab K. Elnaggar, Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia. 3963 Sa’ad Ibn Mu’adh St., Postal Code: 16273 - 7201, Al-Kharj, Saudi Arabia. E-mail: rke_pt2001@yahoo.com.

Abstract: Background:The integration of therapeutic approaches is increasingly recommended for children with cerebral palsy, to enhance outcomes. Nevertheless, clinicians still opt for separate or combined therapies based on little credible knowledge. Objective:This study endeavored to evaluate the effect of botulinum neurotoxin-A (BoNT-A) injection and reciprocal neuromuscular electrical stimulation (rNMES) and their combination on the upper extremity function in children with spastic hemiplegia. Methods:Sixty-four children with spastic hemiplegia (aged 6– 10 years) were randomly assigned to four treatment-based groups [group I (BoNT-A), group II (rNMES), group III (combined BoNT-A and rNMES), and group IV (Control)]. All children received a physical rehabilitation program, thrice/week over three months. Unilateral upper-limb function, bimanual hand function, and real-time arm-hand function were assessed using Melbourne Assessment (MA), Assisting Hand Assessment (AHA), and Pediatric Motor Activity Log (PMAL) scales respectively pre-treatment, post-treatment, and at 6 months follow-up. Results:Post-treatment, group III achieved greater improvement in MA, AHA, and PMAL compared to other groups (all P < 0.05), and the difference remained in favor of group III at the follow-up (all P < 0.05). Conclusions:This study suggests that BoNT-A and rNMES combined are more effective than either of them alone to enhance upper-extremity function in children with spastic hemiplegia.

Keywords: Cerebral palsy, muscle co-activation, electrical stimulation, botulinum-A toxin, upper extremity function

DOI: 10.3233/RNN-201088

Journal: Restorative Neurology and Neuroscience, vol. 38, no. 6, pp. 431-441, 2020