P 69 Advantages of spasticity treatment with botulinum toxin A in combination with controlled dynamic stretching orthoses for the treatment of contractures compared to botulinum toxin A as the only therapy

Abstract

Background: Spasticity occurs in about 80% of children with cerebral palsy. Secondary to spasticity, contractures may also occur. Botulinum toxin A (BTA) is used to treat spasticity but not contractures. Therefore, when spasticity and contracture are present, BTA is used in combination with serial casting. The positive effect of a serial casting is to improve passive range of motion (PROM), but it can also bring skin irritation/infection, compression damage and pain as common problems. In addition, active PT is usually not possible for 6 weeks while wearing the cast. Controlled-dynamic-stretching (CDS) orthoses offer the advantages of active PT after BTA, as well as easier control of the skin findings due to the removability. Hypothesis: The combination of BTA with CDS orthoses in the presence of spasticity and contracture produces more positive results in terms of ankle PROM than treatment with BTA alone. Method: The case group included treatment of the calf muscles with BTA in combination with CDS orthoses. The control group included treatment of the calf muscles with BTA only. Data from both treatment options were retrospectively compared with the primary endpoint of change in PROM of the ankle. Results: The case group showed significant improvements at 1 (median 10° (p=0.019)) and 3 months (median 10° (p=0.016)) post-injection. This decreased to a median of 0° (p=0.152) by 6 months after the injections. In the control group, no significant changes were observed at 1 (median 5° (p=0.340)), 3 (median 0° (p=0.453)) and 6 (median -5° (p=0.353)) months after injection. Conclusion: The combination therapy of BTA with CDS orthoses shows promising results in terms of improvement of PROM. This success could mean more comfortable treatment options for children with calf muscle spasticity in the future.