Effect of the Functional Train after Chemical Blockade in Children with Cerebral Palsy

Case Report

Authors

  • Bruna Mello Bernardi Fisioterapeuta, especializanda em Fisioterapia Motora Hospitalar e Ambulatorial aplicada à Neurologia pela UNIFESP, São Paulo-SP, Brasil
  • Anna Amélia Pereira da Motta Fisioterapeuta, especialista em Fisioterapia Motora Hospitalar e Ambulatorial aplicada à Neurologia pela UNIFESP, São Paulo-SP, Brasil
  • Kátia Maria Gonçalves Allegretti Fisioterapeuta, especialista em Fisioterapia Motora Hospitalar e Ambulatorial aplicada à Neurologia pela UNIFESP, São Paulo-SP, Brasil.
  • Vanessa Costa Monteiro Fisioterapeuta, especialista em Fisioterapia Motora Hospitalar e Ambulatorial aplicada à Neurologia pela UNIFESP, São Paulo-SP, Brasil.
  • Heloíse Cazangi Borges Fisioterapeuta, especialista em Fisioterapia Motora Hospitalar e Ambulatorial aplicada à Neurologia pela UNIFESP, São Paulo-SP, Brasil
  • Therezinha Rosane Chamlian Médica, Doutora, Professora Afiliada Chefe da Clínica da Disciplina de Fisiatria do Departamento de Ortopedia e Traumatologia da UNIFESP e Diretora Técnica do Lar Escola São Francisco, São Paulo-SP, Brasil
  • Danilo Masiero Médico, Doutor, Professor Associado Chefe da Disciplina de Fisiatria do Departamento de Ortopedia e Traumatologia da UNIFESP, São Paulo-SP, Brasil.

DOI:

https://doi.org/10.34024/rnc.2010.v18.8493

Keywords:

Cerebral Palsy, Neuromuscular Blockade, Physical Therapy, Functioning

Abstract

Objective. to evaluate the effects of functional training after chemical blocking in motor function in the passive range of motion and spasticity in children with spastic cerebral palsy. Method. 5 patients were selected, but only 1 completed the study. The patient LGP diagnosed with diplegic cerebral palsy, male, and 6 years old was assessed before and after chemical blocking and post physiotherapeutic intervention. Items valued injury gross motor function by the Gross Motor Function Measure (GMFM), amplitude of movement (WMD) by a passive technique for measuring angles, and the degree of spasticity Scale Modified From Ashworth. The physiotherapeutic intervention consisted of 12 sessions of functional training, with duration of 1 hour each session. Results. an increase was observed in scores of GMFM and the values of passive ADM on 3 ratings, with little change in the degree of spasticity. Final considerations. in this case studied was no improvement of functional abilities with the functional training after chemical blocking. However, we suggest more research with a larger sample for proof of results.

Metrics

Metrics Loading ...

References

Araújo BA, Formiga CKMR, Tudella E. Utilização da toxina botulínica tipo A em crianças com paralisia cerebral espástica. Fisioterapia Brasil 2004;5:380-5.

Shepherd RB. Fisioterapia em Pediatria. 3ª. ed. São Paulo: Santos, 2006, 421p.

Damiano DL, Abel MF. Functional outcomes of strength training in spastic cerebral palsy. Arch Phys Med Rehabil 1998;79:119-25.

Dodd KJ, Taylor NF, Graham HK. A randomized clinical trial of strength training in young people with cerebral palsy. Dev Med Chil Neurol 2003;45:652-7.

Rodda J, Graham HK. Classification of gait patterns in spastic hemiplegia and spastic diplegia: a basis for a management algorithm. Euro J Neurol 2001;8(supl. 5):98-108.

Silva JAT, Magalhães AAC, Masiero D, Dias LS. Tratamento das deformidades em equino de pacientes portadores de paralisia cerebral do tipo diplégico espástico mediante injeção de toxina botulínica tipo A em músculos gastrocnêmios. Rev Bras Ortop 2003;38:41-55.

Galen SS, Granat MH. Study of the effect of Functional Electrical Stimulation (FES) on walking in children undergoing Botulinum Toxin A therapy. In: Proceedings of the First FESnet Conference. Hunt KJ, Granat MH (ed). Glasgow: University of Strathclyde, 2002, p.31-2.

Dimitrijevic MR, Nathan PW. Studies of spasticity in man - some features of spasticity. Brain 1967;90:130.

Ade-Hall RA, Moore AP. Botulinum toxin type A in the treatment of lower limb spasticity in cerebral palsy. Cochrane Database Syst Rev 2000; 2: CD001408.

Brigídio P A F. Estudo de evolução a longo prazo de pacientes portadores de paralisia cerebral do tipo espástico submetidos a neurólise química com toxina botulínica A, associada ou não ao fenol e fisioterapia [tese]. São Paulo: Universidade Federal de São Paulo; 2004.

Botelho LAA, Granero LHCM, Masiero D. A neurólise química simultânea com fenol e toxina botulínica do tipo A para o tratamento da espasticidade em 67 pacientes. Med Reabil 2002;59:20-4.

Hesse S, Reiter F, Konrad M. Botulinum toxin type A and short-therm electrical stimulation in the treatament of upper limb flexor spasticity after strock: a randomised, double blind, placebo controlled trial. Clin rehabil 1998; 12:381-8.

Koman LA, Mooney JF, Smith BP, Goodman A, Mulvaney T. Management of spasticity in cerebral palsy with botulinum-A toxin: report of a preliminary, randomized, doble-blind study. J Pediatr Orthop 1994;14:299-303.

Sauron FN. Terapia Física. In: Casalis MEP. Reabilitação – espasticidade. São Paulo: Atheneu; 1990, p.35-48.

Baker R, Jasinski M, Maciag-Tymecka I, Michalowska-Mrozek J, Bonikowski M, Carr L, et al. Botulinum toxin treatment of spasticity in diplegic cerebral palsy: a randomized, doublé-blind, placebo-controlled, dose-ranging study. Dev Med Chil Neurol 2002;44:666-75.

Chutorian AM, Root L. Management of spasticity in children with botulinum-A toxin. Int Pediatrics 1994; 9:35 43.

Love SC, Valentine JP, Blair EM, Price CJ, Cole JH, Chauvel PJ. The effect of botulinum toxin type A on the functional ability of the child with spastic hemiplegia: a randomized controlled trial. Eur J Neurol 2001;8:50-8.

Stawek J, Klimont L. Functional improvement in cerebral palsy patients treated with botulinum toxin A injections – preliminary results. Eur J Neurol 2003;10:313-7.

Lannin N, Scheinberg A, Clark K. AACPDM systematic review of the effectiveness of therapy for children with cerebral palsy after botulinum toxin A injections. Dev Med Chil Neurol 2006;48:533-9.

Dumas HM, O’Neil ME, Fragala MA. Expert consensus on physical therapist intervention after botulinum toxin A injection for children with cerebral palsy. Pediatr Phys Ther 2001;13:122-32.

Mulligan H, Wilmshurts E. Physiotherapy assessment and treatment for an ambulant child with cerebral palsy after botox A to the lower limbs: a case report. Pediatr Phys Ther 2006;18:39-48.

Baiocato AC, Rozestraten FS, Oliveira TR, Carvalho CMM. Uso da toxina botulínica tipo A como coadjuvante no tratamento da espasticidade: uma revisão da literatura. Fisiot Mov 2000;12:33-46.

Quagliato EMAB. Toxina botulínica A no tratamento da espasticidade. In: Souza AMC, Ferrareto I. Paralisia cerebral: aspectos práticos. São Paulo: Memnon; 1998, p.38-43.

Jefferson RJ. Botulinum toxin in the management of cerebral palsy. Dev. Med. Chil. Neurol 2004;46:491-9.

Shumway-Cook A, Woollacott MH. Controle motor- teoria e aplicações práticas. 2ª. ed. São Paulo: Manole, 2003, 592p.

Shepherd R, Carr J. Ciência do Movimento: fundamentos para a fisioterapia na reabilitação. 2ª. ed. São Paulo: Manole, 2003, 220p.

Ahl LE, Johansson E, Granat T, Carlberg EB. Functional therapy for children with cerebral palsy: ecological approach. Dev Med Child Neurol 2005;47: 613-9.

Russel DJ, Avery LM, Rosenbaum PL, Raina PS, Walter SD, Palasiano RJ. Improved scaling of the Gross Motor Function Measure for children with cerebral palsy – evidence of reability and validity. Phys Ther 2000;80:873-8.

Norkin CC, White DJ. Medida do Movimento Articular – Manual de Goniometria. 2ª. ed. Porto Alegre: Artes Médicas; 1997, 260p.

Damiano DL, Quinlivan JM, Owen BF, Payne P, Nelson KC, Abel MF. What does the Ashworth scale really measure and are instrumented measures more valid and precise? Dev Med Child Neurol 2002;44:112-8.

Published

2010-06-30

Issue

Section

Relato de Caso

How to Cite

1.
Bernardi BM, da Motta AAP, Allegretti KMG, Monteiro VC, Borges HC, Chamlian TR, et al. Effect of the Functional Train after Chemical Blockade in Children with Cerebral Palsy: Case Report. Rev Neurocienc [Internet]. 2010 Jun. 30 [cited 2025 Dec. 16];18(2):166-71. Available from: https://periodicos.unifesp.br/index.php/neurociencias/article/view/8493