Ann Rehabil Med.  2012 Jun;36(3):400-403. 10.5535/arm.2012.36.3.400.

The Change of Intrinsic Stiffness in Gastrocnemius after Intensive Rehabilitation with Botulinum Toxin A Injection in Spastic Diplegic Cerebral Palsy

• Kwon DR
• Park GY
• Kwon JG

• KMID: 2266747
• DOI: http://doi.org/10.5535/arm.2012.36.3.400

Abstract

A recent study claimed that botulinum toxin A (BTX-A) injection into the calf muscle of cerebral palsy (CP) children did not change the intrinsic stiffness. Contrary to this recent report, in our case, decreased muscle spasticity, which was measured using a modified Ashworth scale, and increased Gross Motor Function Measure score were demonstrated at 4 weeks after intensive rehabilitation treatment (IRT) with BTX-A injection to the medial gastrocnemius muscle in a child with spastic CP. Additionally, we indentified decreased muscle stiffness which was demonstrated by a decrease in the color-coded scale and shear velocity, and an increase in the strain ratio using dynamic sonoelastography.

Keyword

Cerebral palsy; Spasticity; Dynamic sonoelastography

MeSH Terms

Botulinum Toxins
Cerebral Palsy
Child
Elasticity Imaging Techniques
Humans
Muscle Spasticity
Muscle, Skeletal
Muscles
Sprains and Strains
Botulinum Toxins

Figure

• 

  Fig. 1 Sonoelastographic image presentation of local muscle stiffness superimposed on the longitudinal B-mode ultrasound image of the right medial gastrocnemius (GCM) muscle before intensive rehabilitation treatment with BTX-A injection. (A) Sonoelastographic image (right) showed yellow to red coloring (arrow). (B) Strain ratio between gastrocnemius and soleus muscles demonstrated 0.62. (C, D) Shear velocity in the medial GCM muscle and soleus muscle region revealed 2.69 m/s and 1.73 m/s, respectively.

• 

  Fig. 2 Sonoelastographic image presentation of local muscle stiffness superimposed on the longitudinal B-mode ultrasound image of the right medial gastrocnemius (GCM) muscle at 4 weeks intensive rehabilitation treatment with BTX-A injection. (A) Sonoelastographic image (right) showed purple to green coloring (arrow). (B) Strain ratio between gastrocnemius and soleus muscles demonstrated 2.04. (C, D) Shear velocity in the medial GCM muscle and soleus muscle region revealed 1.97 m/s and 1.85 m/s, respectively.

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