CEREBRAL-PALSY - A RATIONAL APPROACH TO A TREATMENT PROTOCOL, AND THEROLE OF BOTULINUM TOXIN IN TREATMENT

Cerebral palsy (CP) is characterized by aberrant control of movement o r posture and appears early in life secondary to central nervous syste m damage. The symptoms of CP fall into four groups: symptoms due to lo ss of selective motor control; symptoms due to abnormal muscle tone; s ymptoms due to imbalance between muscle agonists and antagonists; and symptoms due to impaired balance. The goals of treatment are to maximi ze Function and minimize the development of joint contracture and othe r secondary problems. Development of a treatment plan begins with the definition of objectives and consideration of the effects of growth an d development on the patient's abilities. The role of botulinum toxin in CP treatment has grown in recent years. The patient who could benef it most from botulinum toxin treatment is one who is hypertonic and wh ose abnormal muscle tone is interfering with function, or who is expec ted to develop joint contracture with growth because of this abnormal tone. By altering this muscle tone, Function can be enhanced or additi onal therapeutic modalities can be employed. Assessing treatment outco mes for BTX injection involves the same set of questions and measureme nts as for other types oi treatments and depends on dhe careful defini tion of treatment objectives beforehand. (C) 1997 John Wiley & Sons, I nc.