Novita Research Report - 2004 to 2007 - Novita Children's Services

21SummaryDynamic equinus (spasticity of the calf muscles) occurs commonly in children with cerebralpalsy and is the focus of numerous treatments including serial casting, orthoses, nightsplinting, injection with BoNT-A and physiotherapy. It is now common practice in SouthAustralia to use serial casting routinely as adjunctive treatment post-BoNT-A, on the premisethat it will enhance and increase the duration of the effects of BoNT-A treatment. Howeverthere is very little evidence available supporting the use of such combination interventions forchildren with cerebral palsy.This study aims to investigate the role of serial casting post-BoNT-A injections for childrenwith cerebral palsy and develop clinical and functional indicators for casting selection afterBoNT-A treatment.MethodNovita clients with hemiplegic or diplegic cerebral palsy aged between two and 16 years,who had planned to have BoNT-A treatment to their calf muscles, were invited to participate.Consenting participants had measures prior to BoNT-A treatment, then at four weeks, 12weeks and six months post-BoNT-A injection. Outcome measures included calf range ofmotion (goniometry), spasticity (Tardieu and Modified Ashworth Scale), Selective MotorControl, gait analysis (Observational Gait Scale), level of gross motor function (Gross MotorFunction Measure) and parental/child goals (Canadian Occupational Performance Measure).Ten days post-BoNT-A injection, participants were reviewed by the research team forconsideration for serial casting. Participants deemed as meeting Novita’s current castingcriteria were randomly assigned to either a casting or a control (no casting) group usingminimisation. This method allowed for the two groups to be matched for age range (two tofive, six to nine or 10-16 years), diagnosis (hemiplegia or diplegia) and GMFCS level (I, II orIII) while maintaining an element of randomisation. All participants received night splints,orthoses (where required), exercises and an exercise diary.Appropriate statistics will be used to determine if there are differences between the treatmentgroups for the outcome measures.ResultsImplicationsTwenty three participants (six hemiplegia, 17 diplegia) were recruited. GMFCS levels ofparticipants were level I (14), level II (six) and level III (three). Ages at BoNT-A injectionwere two to five years (13), six to nine years (nine) and 10-16 years (one). All data hasbeen completed for 20 participants, follow-up measures are being completed for threeparticipants, with the last participant due for measures in early November 2007.For clients – to ensure children with cerebral palsy and their families, receive the best practicemanagement for dynamic equines.For services – the findings of this study will ensure physiotherapists use resources suchas therapy time and splinting materials efficiently and in accordance with evidence-basedpractice.StatusOngoing