Robotic training of children with crouch gait improved posture and walking by enhancing muscle strength and coordination.

BACKGROUND: Botulinum toxin A (BoNT-A) is a well-accepted treatment for the medical management of spasticity in children with cerebral palsy (CP). OBJECTIVE: To assess the efficacy and safety of BoNT-A compared with other treatment options in managing lower limb spasticity in children with CP. METHODS: A summary of the Cochrane Review update by Blumetti et al. (2019), with comments. RESULTS: This review included 31 randomized controlled trials (1508 participants). Compared with usual care/physiotherapy, the evidence is very uncertain about the effect of BoNT-A on gait, function, ankle joint range of motion (ROM), satisfaction, and ankle spasticity in children with CP. Compared with placebo/sham, BoNT-A probably benefits these same outcomes, although the results for function are contradictory. BoNT-A may not be more effective than serial casting at improving gait, function, ankle ROM and spasticity at any time point. However, it may be more effective than an orthosis at medium-term follow-up for hip ROM and adductor spasticity, but not function. The rate of adverse events with BoNT-A is similar to placebo/sham and serial casting. CONCLUSIONS: Evidence for the effectiveness and safety of BoNT-A for the management of lower limb spasticity in children with CP is uncertain, with better quality evidence available from studies of placebo/sham than non-placebo controls. To produce high-quality evidence, future studies need to improve their methodological quality and increase sample sizes.

OBJECTIVE: To evaluate the safety of combining salivary gland onabotulinumtoxinA (BTX-A) injections for sialorrhea with intramuscular BTX-A injections for spasticity in the same procedure. DESIGN: A retrospective cohort study in a tertiary hospital c

Robotic gait training may improve overground ambulation for individuals with poor control over pelvic motion. However, there is a need for an overground gait training robotic device that allows full control of pelvic movement and synchronizes applied forces to the user’s gait. This work evaluates an overground robotic gait trainer that applies synchronized forces on the user’s pelvis, the mobile Tethered Pelvic Assist Device. To illustrate one possible control scheme, we apply an assistive frontal plane pelvic moments synchronized with the user’s continuous gait in real-time. Ten healthy adults walked with the robotic device, with and without frontal plane moments. The frontal plane moments corresponded to 10% of the user’s body weight with a moment arm of half their pelvic width. The frontal plane moments significantly increased the range of frontal plane pelvic angles from 2.6° to 9.9° and the sagittal and transverse planes from 4.6° to 10.1° and 3.0° to 8.3°, respectively. The frontal plane moments also significantly increased the activation of the left gluteus medius muscle, which assists in regulating pelvic obliquity. The right gluteus medius muscle activation did not significantly differ when frontal plane moments were applied. This work highlights the ability of the mobile Tethered Pelvic Assist Device to apply a continuous pelvic moment that is synchronized with the user’s gait cycle. This capability could change how overground robotic gait training strategies are designed and applied. The potential for gait training interventions that target gait deficits or muscle weakness can now be explored with the mobile Tethered Pelvic Assist Device.

Cerebral palsy (CP) is a group of non-progressive disorders of motor function in children resulting from an injury to an immature brain. In addition to abnormal limb and trunk movement, individuals with CP can experience involuntary muscle contractions of the lower facial muscle groups, causing oromandibular dystonia (OMD). Contraction of the lateral pterygoids and submandibular muscles depresses the mandible. OMD involving the lateral pterygoids can therefore lead to involuntary jaw opening posture, affecting the ability to feed and speak effectively. We present a case series of five patients with CP and OMD that received novel ultrasound-guided onabotulinumtoxinA to the lateral pterygoid muscles. Our goal was to determine if chemodenervation would improve the mouth-closing ability, thus in turn improving the ability to swallow, chew, manage secretions, and communicate. We describe this unique injection method and report a subjective improvement in eating abilities and communication, in addition to a positive upward trend in most patients’ weights, with no significant adverse side effects.

Aim: We hypothesized that repeat onabotulinumtoxinA (BTX-A) injections to salivary glands would have a cumulative effect on drooling, leading to prolonged efficacy duration. Methods: We retrospectively reviewed medical records and conducted a telephone survey of individuals treated with BTX-A to the salivary glands to investigate ongoing efficacy or adverse effects. Outcome measures were duration of decrease in drooling and adverse events. The main independent variable was the number of injections. We identified 52 consecutive individuals (26 females) with cerebral palsy with an average age of 9 yrs, 3 mos ± 5 yrs 2 mos, who had received BTX-A for sialorrhea. Results: Linear regression analysis showed that each additional injection resulted in the duration of efficacy being 0.68 mos longer (P < 0.001, R ² = 0.47). Age, sex, Gross Motor Function Classification System level, presence of tube feeding, presence of tracheostomy, gastroesophageal reflex, seizures, and concurrent intramuscular injections seizures were not significant contributors to the association between injection number and efficacy duration (F (6, 45) = 1.01, P = 0.431). Interpretation: There may be a cumulative effect of BTX-A injections to the salivary glands, resulting in longer periods of efficacy with consecutive injection.