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Sonographic and clinical effects of Botulinum Toxin Type A combined with extracorporeal shock wave therapy on spastic muscles of children with cerebral palsy
Picelli A, la Marchina E, Gajofatto F, Pontillo A, Vangelista A, Filippini R, Baricich A, Cisari C, Smania N
Developmental Neurorehabilitation 2017;20(3):160-164
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: The aim of this study was to compare the combined sonographic and clinical effects of Botulinum Toxin Type A (BoNT-A) and extracorporeal shock wave therapy (ESWT) versus BoNT-A alone in children with cerebral palsy. METHODS: Ten children with spastic cerebral palsy were randomly assigned to one of two groups. Group 1 received BoNT-A injection into the spastic muscles of the affected limbs plus three ESWT sessions. Group 2 received BoNT-A alone. Assessment was performed before and 1 month after injection. Sonographic outcomes were injected muscles echo intensity and their hardness percentage, and clinical outcomes the modified Ashworth scale and the Tardieu scale. RESULTS: At 1- month evaluation, significant differences in the injected muscles percentage of hardness (p = 0.021) and the modified Ashworth scale (p = 0.001) were found between groups. CONCLUSIONS: Our results support the hypothesis that the combined effects of BoNT-A and ESWT derive from their respective action on neurological and non-neural rheological components in spastic muscles.

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