CEREBRAL palsy, MEDICAL personnel, MEDICAL care, PRIMARY care, LIKERT scale, RESEARCH, RESEARCH methodology, EVALUATION research, MEDICAL cooperation, MEDICAL protocols, COMPARATIVE studies, MEDICAL referrals, RESEARCH funding, DELPHI method
Abstract
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Warnink‐Kavelaars, Jessica, Vermeulen, R Jeroen, Buizer, Annemieke I, and Becher, Jules G
Subjects
CEREBRAL palsy treatment, BOTULINUM toxin, THERAPEUTICS, CHILDREN with cerebral palsy, TREATMENT effectiveness, ELECTRIC stimulation, MEDICAL protocols, CEREBRAL palsy, COMPARATIVE studies, INJECTIONS, INTRAMUSCULAR injections, RESEARCH methodology, MEDICAL cooperation, MUSCLE relaxants, RESEARCH, EVALUATION research, SKELETAL muscle
Abstract
Aim: To validate a detailed intramuscular needle placement protocol using passive muscle stretching and relaxing for botulinum neurotoxin type A (BoNT-A) treatment in the lower extremity of children with spastic cerebral palsy (CP), with verification by electrical stimulation.Method: A prospective observational study was performed in 75 children with spastic CP who received regular BoNT-A treatment under general anaesthesia (52 males, 23 females; mean age 8y 9mo, SD 3y 7mo, range 4-18y; mean body mass index 16.2, SD 3.7, range 7.7-26.7). A total of 1084 intramuscular needle placements using passive muscle stretching and relaxing were verified by electrical stimulation. Primary outcome was the positive predictive value.Results: Intramuscular needle placement in the muscles adductor brevis, adductor longus, gracilis, semimembranosus, semitendinosus, biceps femoris, rectus femoris, and lateral and medial heads of the gastrocnemius and soleus had a positive predictive value ranging from 85.7% to 100% (95% confidence interval ranging from 71.5-89.9% to 91.4-100%).Interpretation: This validated detailed protocol for intramuscular needle placement using passive muscle stretching and relaxing for BoNT-A treatment in the lower extremity of children with spastic CP is reliable and has a high positive predictive value. [ABSTRACT FROM AUTHOR]