Botulinum toxin A treatment in toddlers with cerebral palsy.

AIMS: In this study the aim was to evaluate the effect of botulinum toxin A (BoNT-A) treatment on muscle tone, contracture development and gait pattern in young children with cerebral palsy (CP). METHOD: Fifteen children with spastic CP (mean age = 16 months) were included in a randomized control study. All received a daily stretching programme and children in the BoNT-A group additionally received two injections, 6 months apart in the gastrocnemius muscle. Outcomes were assessed at baseline, and after 1 and 3.5 years. A 3D gait-analysis was performed at 5 years of age. RESULTS: Plantarflexor muscle tone in the BoNT-A group was significantly reduced after 3.5 years, while the muscle tone at the ankle and knee in the control group remained unchanged. The change-score in knee-flexion muscle tone between the groups was significantly different after 3.5 years. The knee joint ROM was significantly increased at 1 year in the BoNT-A group but reduced at the knee and ankle joints in the control group after 3.5 years. No group differences were found for gait analysis, GMFM-66 or PEDI. CONCLUSION: Early treatment of BoNT-A in children with spastic CP may decrease muscle tone and decelerate contracture development after 3.5 years. The effect on gait development remains inconclusive.

Developmental profiles and auditory perception in 25 children attending special preschools for language-impaired children.

AIM: To study different developmental profiles and auditory perception in a representative group of children with language impairment (LI). METHODS: A multidisciplinary investigation was carried out in a group of 25 children attending units specifically for language-impaired children. An assessment of the cognitive level, motor performance, behaviour and auditory perception was performed and the results were compared with those for age-matched groups of children. RESULTS: Among those with moderate or severe language impairment (LI), around 90% had additional developmental disorders. In three tests of auditory perception, children with LI had problems with working memory and speech discrimination. No problems were found with the children's temporal resolution in auditory perception. Another conclusion from the auditory perceptual tests was that the children's cognitive abilities were important for their success in these tests. CONCLUSION: Neurodevelopmental deviations are very common in LI children. The optimal route for the assessment and treatment of these children would be a multidisciplinary approach.