Abstract
Park G-Y, Kwon DR. Sonoelastographic evaluation of medial gastrocnemius muscles intrinsic
stiffness after rehabilitation therapy with botulinum toxin A injection in spastic
cerebral palsy.
Objective
To investigate intrinsic stiffness changes using real-time sonoelastography (RTS)
in the medial gastrocnemius muscle (GCM) after rehabilitation therapy with botulinum
toxin type A (BTA) injection in spastic cerebral palsy (CP).
Design
Prospective study using ultrasonography and RTS.
Setting
An inpatient rehabilitation clinic.
Participants
Children (N=17) with spastic CP (mean age, 57±22y, age range, 26–110mo).
Intervention
Rehabilitation therapy and intramuscular injection of BTA in both medial and lateral
GCMs.
Main Outcome Measures
RTS was obtained on the medial GCM, and the elastic pattern of the medial GCM was
graded from RTS 1 (purple to green: soft) to RTS 4 (red: stiff) on the basis of color-scaled
RTS. RTS score, color histogram, Modified Ashworth Scale (MAS) score of the ankle
plantar flexor muscles, and Gross Motor Function Measure (GMFM) score were obtained
before intervention and 4 weeks after intervention. The correlations among RTS score,
GMFM, and MAS score were determined. Intrarater reliability was also evaluated.
Results
Before and at 4 weeks after intervention, the mean RTS score decreased from 3.4 to
1.5 (P<.05), median red pixel intensity decreased from 112.5 to 101.3 (P<.05), median blue pixel intensity increased from 82.6 to 90.4 (P<.05), mean MAS score of the ankle decreased from 2.7 to 1.3 (P<.05), and mean GMFM score increased from 54.55% to 62.32%. Significant correlations
were observed between the RTS score and the MAS score. Intrarater reliability was
high.
Conclusions
Our results suggest that more information about the change of spastic muscle in CP
after rehabilitation treatment with BTA may be gained by estimating muscle stiffness
using RTS combined with clinical scale measurements.
Key Words
List of Abbreviations:
BTA (botulinum toxin type A), CP (cerebral palsy), GCM (gastrocnemius muscle), GMFM (Gross Motor Function Measure), ICC (intraclass correlation coefficient), MAS (Modified Ashworth Scale), ROI (region of interest), RTS (real-time sonoelastography)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 09, 2012
Footnotes
Supported by the Research Institute of Medical Science, Catholic University of Daegu (2011) (grant no. 201101).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Reprints are not available from the author.
In-press corrected proof published online on Aug 30, 2012, at www.archives-pmr.org.
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
