Bs. Russman et al., CEREBRAL-PALSY - A RATIONAL APPROACH TO A TREATMENT PROTOCOL, AND THEROLE OF BOTULINUM TOXIN IN TREATMENT, Muscle & nerve, 1997, pp. 181-193
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.