Two Different Methods of Botulnium Toxin A Injection for Releasing of Hip Adductor Spasticity in Diplegic Children

Aim: To compare the effects of Botulnium Toxin A injection of hip adductor muscles (adductor longus and brevis) and gracilis muscle on motor function, balance and gait parameters of the children with diplegic cerebral palsy.
Study Design: Prospective, randomized controlled study.
Place and Duration of Study: National Institute for Neuro-Motor System, Out-patient Clinic, Faculty of Physical Therapy, Cairo University and Kasr El Aini Hospital from June 2013 to September 2014
Methodology: Thirty diplegic cerebral palsied children of both sexes were selected. Their ages ranged from 8 to 10 years. They were assigned randomly into two equal study groups. Group I received Botulnium Toxin A injection of bilateral adductor longus and brevis muscles, while group II received Botulnium Toxin A injection of bilateral gracilis muscles. In addition, both groups received the same designed physical therapy program three times per week for three successive months. Gross Motor Function Measure-88 standing and walking subsections, stability indices, kinematic gait parameters were evaluated before and after three successive months of treatment.
Results: Significant differences were observed in both groups when comparing their pre and post treatment mean values of all measuring variables (P <0.05) except non significant differences of mediolateral stability index in group I was recorded (P > 0.05). Also, significant differences were recorded when comparing the post treatment mean values of all measuring variables of both groups in favor of group II (P <0.05).
Conclusion: Botulnium Toxin A injection of the gracilis muscle is an excellent supplement to regularly scheduled physical therapy intervention for children with diplegic cerebral palsy.