The effectiveness of combined use of botulinum toxin therapy and functional electrical stimulation in ambulatory patients with spastic forms of cerebral palsy

Introduction. Cerebral palsy (CP) is a severe neurological disease, the clinical picture of which is dominated by motor disorders. In spastic forms of CP, in addition to increasing muscle tone and spasticity, a significant number of muscles are functionally weakened with signs of paresis. To correct these disorders, close attention has recently been paid to two therapeutic approaches — botulinum therapy and functional electrical stimulation (FES). The purpose of our investigation was to study the efficiency of combined use of botulinum therapy and FES in children with CP levels I-III according to the Gross Motor Function Classification System (GMFCS). Material and methods. The study included 40 CP patients. 20 children (10 with spastic diplegia and 10 with hemiplegic form) treated with Abobotulinumtoxin A and FES formed the main group. The control group included 20 children (11 with spastic diplegia and 9 with hemiplegic form) who received botulinum therapy without subsequent FES. Results. When evaluated 2 weeks later (after the end of the course of treatment) an increased muscle tone and spasticity of the gastrocnemius muscles significantly decreased in both the main and control groups. Following the complex treatment of Abobotulinum toxin A in combination with FES the range of motion in the ankle joint in the main group was significantly greater than in the control group. These differences in the increase in the range of motion were observed both during passive dorsiflexion of the foot ( p =0.044) and when patients performed maximum voluntary muscle contraction ( p =0.036). Conclusion. In the main group of patients, the combined use of botulinum therapy and FES proved to be highly effective in correcting spasticity and increasing the range of motion in the ankle joint. The course of FES performed in patients of the main group has an additional therapeutic effect, which in complex treatment gives a significantly greater positive result.