Abstract
Comprehensive instrumented muscle and joint assessments should be considered when prescribing Botulinum NeuroToxin‐A (BoNT‐A) treatment in spastic paresis. In a child with spastic paresis, comprehensive evaluation following treatment with BoNT‐A, serial casting, and physiotherapy showed that short‐term improvements in gait occurred without changes in muscle morphology. Rather, foot flexibility increased.
Highlights
In children with spastic paresis (SP), gait deviations, including limited dorsiflexion during the stance phase, are generally attributed to calf muscle spasticity and non‐neural changes in soft tissue properties.[1]
To target the changes in soft tissue properties that contribute to reduced ankle dorsiflexion, Botulinum NeuroToxin‐A (BoNT‐A) is often combined with serial casting of the lower leg such that the plantar flexor muscles are gradually stretched
We found short‐term improvements in gait that were accompanied by a large reduction in calf muscle hyperactivity and improved ankle range of motion (ROM) after BoNT‐A injections combined with serial casting and physiotherapy in a child with SP
Summary
In children with spastic paresis (SP), gait deviations, including limited dorsiflexion during the stance phase, are generally attributed to calf muscle spasticity and non‐neural changes in soft tissue properties.[1]. BoNT‐A results in a temporary blockage of the neurotransmission of acetylcholine to the nerves motor endplates.[2] To target the changes in soft tissue properties that contribute to reduced ankle dorsiflexion, BoNT‐A is often combined with serial casting of the lower leg such that the plantar flexor muscles are gradually stretched. In such a combined treatment approach, it is presumed that after decreasing muscular activation with BoNT‐A, serial casting of muscles at an extended length.
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