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Adjunct therapies to improve outcomes after botulinum toxin injection in children: A systematic review - 14/07/19

Doi : 10.1016/j.rehab.2018.06.010 
L. Mathevon a, , I. Bonan b, J.-L. Barnais c, F. Boyer d, M. Dinomais e
a Department of Physical and Rehabilitation Medicine, CHU de Grenoble, 38000 Grenoble, France 
b Department of Physical and Rehabilitation Medicine, University of Rennes, CHU de Rennes, 35000 Rennes, France 
c Department of Physical and Rehabilitation Medicine, CHU de Martinique, 97200 Martinique, France 
d Department of Physical and Rehabilitation Medicine, University of Reims, CHU de Reims, 51100 Reims, France 
e Department of Physical and Rehabilitation Medicine, University of Angers, CHU de Angers & Les Capucins Angers, 49000 Angers, France 

Corresponding author. 9, bis impasse de l’Aigas, 69160 Tassin la Demi-Lune, France.9, bis impasse de l’AigasTassin la Demi-Lune69160France

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Abstract

Background

Botulinum toxin (BTX) injection alone is not sufficient to treat spasticity in children, notably those with cerebral palsy; thus, there is an emerging trend for adjunct therapies to offer greater outcomes than BTX alone.

Objective

The aim of this systematic review was to evaluate the general effectiveness of adjunct therapies regardless of their nature in children with spasticity.

Methods

Medline, Cochrane and Embase databases were searched from January 1980 to March 15, 2018 for reports of parallel-group trials (randomized controlled trials [RCTs] and non-RCTs) assessing adjunct therapies after BTX injection for treating spasticity in children. Two independent reviewers extracted data and assessed the risk of bias by using the PEDro scale for RCTs and Downs and Black scale (D&B) for non-RCTs.

Results

Overall, 20 articles involving 662 participants met the inclusion criteria. The average quality was good for the 16 RCTs (mean PEDro score 7.4 [SD 1.6]) and poor to moderate for the 4 non-RCTs (D&B score 9 to 17). Adjunct therapies consisted of casting/posture, electrical stimulation, resistance training and rehabilitation programmes. Casting associated with BTX injection improved the range of passive and active motion and reduced spasticity better than did BTX alone (9 studies), with a follow-up of 1 year. Resistance training enhanced the quality and performance of muscles without increasing spasticity. Only 3 rehabilitation programmes were studied, with encouraging results for activities.

Conclusion

Lower-limb posture with casting in children has a high level of evidence, but the long-term efficacy of short-leg casting needs to be evaluated. A comparison between the different modalities of casting is missing, and studies specifically devoted to testing the different kinds of casting are needed. Moreover, the delay to casting after BTX injection is not clear. Data on electrical stimulation are not conclusive. Despite the small number of studies, resistance training could be an interesting adjunct therapy notably to avoid loss of strength after BTX injection. Rehabilitation programmes after BTX injection still need to be evaluated.

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Keywords : Spasticity, Cerebral palsy, Botulinum toxin, Casting, Rehabilitation programme


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Vol 62 - N° 4

P. 283-290 - juillet 2019 Retour au numéro
Article précédent Article précédent
  • Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis
  • Ana Paula Salazar, Camila Pinto, Joao Victor Ruschel Mossi, Bruno Figueiro, Janice Luisa Lukrafka, Aline Souza Pagnussat
| Article suivant Article suivant
  • Adjuvant treatments associated with botulinum toxin injection for managing spasticity: An overview of the literature
  • Alessandro Picelli, Andrea Santamato, Elena Chemello, Nicoletta Cinone, Carlo Cisari, Marialuisa Gandolfi, Maurizio Ranieri, Nicola Smania, Alessio Baricich

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