Background: The 2010 Cochrane review regarding Botulinum Toxin A (BoNT-A) upper limb injections in children with CP, underlined the need to better define the associated physiotherapy treatment. Through an RCT involving 24 children with hemiplegic CP, an attempt was made to define the physiotherapy protocol. The results confirmed the determinant role of intensive individualized goaldirected physiotherapy in activity domain improvement. Objective: To define precise criteria for individualized physiotherapy planning and a functional exercise inventory after BONT-A injections. Method: After BONT-A injection an individualized physiotherapy programme was created for each child considering not only injected muscles and functional goals but also motor learning capacity and modifiability, pointing, reaching, grasping, manipulating, releasing strategies, sensoryperceptual disorders, bottom-up components, cognitive level, age, sex and personality. Physiotherapeutic treatment consisted of everyday stretching maneuvers, therapeutic exercises and activities organized in three 45 minute weekly sessions, for 24 weeks. Functional individualized goals were established with family and child. The treatment was combined with nighttime positional splints and daytime functional orthoses aimed at facilitating grasping and handling. The therapeutic approach was specific timed to BONT-A action. During the first month therapists focused on segmental treatment such as stretching, with simple unimanual or bimanual exercises; both transitive and intransitive tasks were proposed, aimed at activating muscles antagonistic to injected ones. From the second to the sixth post-injection month increasing complex functional activities, bimanual and unimanual tasks, with or without functional orthoses were utilized. Either motor tasks, requiring previously selective then sequential executive control, or perception oriented tasks were considered. Setting was particularly important in guiding and supporting activities, every exercise was incorporated into a game or routine activity. Toys, common objects or specifically constructed items were used. Repetition was often needed to fix newly learned abilities, but each exercise was slightly modified every few repetitions in order to maintain interest, limit frustration and improve generalization. Family cooperation helped transfer exercised abilities to daily life. Video recording and testing before, during and after treatment were performed. Conclusion:Functional intensive individualized child-focused approach, combining physiotherapy and orthoses, is effective in improving manipulation after botulinum injection. Positive standardized test results (AHA, Abilhand-kids, Shuee, soon to be released data) are encouraging. This approach is limited by the time required for preparing individualized treatments and personalizing settings.
|Data di pubblicazione:||2011|
|Titolo:||Individualized intensive physiotherapy-orthosis treatment in hand functional recovery of children with spastic hemiplegia after botulinum toxin injection|
|Autori:||Ferrari, Adriano; Maoret, A.R.; Filippi, MC; Beccani, L.; Bassi, B; Muzzini, S.|
|Nome del convegno:||European Academy of Childhood Disability 23rd Annual Meeting|
|Luogo del convegno:||Rome, Italy|
|Data del convegno:||8-11 June 2011|
|Titolo del libro:||Special Issue: Abstracts of the European Academy of Childhood Disability 23rd Annual Meeting, 8-11 June 2011, Rome, Italy|
|Volume:||53, issue supplement s3|
|Appare nelle tipologie:||Abstract in Rivista|
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