Effect Of Botulinum Toxin Type A Injection Therapy Combined With Rehabilitatioan Training On Balance Function In Children With Cerebral Palsy (Spastic Hemiplegia)

Objective: To observe the effect of botulinum toxin type A(BTX-A)injection therapy on the balance function of children with cerebral palsy(spastic hemiplegia)by BTX-A injection combined with rehabilitation training.Materials and methods:Eighty ninth children with cerebral palsy(spastic hemiplegia)in the rehabilitation center(inpatient and outpatient)of Hunan Children's Hospital from March 2015 to September 2016 were included in this study.The patients were randomly divided into routine group and BTX-A group,routine group has 48 cases,BTX-A group has 41 cases.Due to the lost to follow up and other reasons,70 cases were included in statistics,and each group has 40 cases.Among the routine group,23 cases of male,12 cases of female,mean age 28.14±6.83 months;Among the BTX-A group,23 cases of male,12 cases of female,mean age 29.14±8.65 months,the general information of all patients were statistical file.The routine group received rehabilitation training,while the BTX-A group was treated with BTX-A injection combined with rehabilitation training.Before treatment and at 6th,12 th month post-therapy,D and E area of the Gross Motor Function Measure table-88(GMFM-88)was employed to evaluate the level of gross motor function,and the Berg balance scale and Tekscan plantar pressure measurement system were employed to evaluate the balance function.Result:(1)The D area score of GMFM-88 difference of the routine group and BTX-A group at different time points were statistically significant(F=433.111,P<0.001),The score in the two groups increased with the prolonging of treatment time,and the score of D area in the BTX-A group was statistically higher than that in the routine group(F=7.703,P=0.007).(2)The E area score of GMFM-88 difference of the routine group and BTX-A group at different time points were statistically significant(F=702.141,P<0.001),The score in the two groups increased with the prolonging of treatment time,and the score of E area in the BTX-A group was statistically higher than that in the routine group(F=5.117,P=0.027).(3)The score of the Berg balance scale difference of the routine group and BTX-A group at different time points were statistically significant(F=925.394,P<0.001),The score in the two groups increased with the prolonging of treatment time,and the score of the Berg balance scale in the BTX-A group was statistically higher than that in the routine group(F=5.027,P=0.028).(4)The percentage of weight support on the affected foot difference of the routine group and BTX-A group at different time points were statistically significant(F=163.362,P<0.001),The percentage in the two groups increased with the prolonging of treatment time,and The percentage of weight support on the affected foot in the BTX-A group was statistically higher than that in the routine group(F=18.564,P<0.001).(5)The trajectory length per unite time difference of the routine group and BTX-A group at different time points were statistically significant(F=346.110,P<0.001),the trajectory length per unite time in the two groups reduced with the prolonging of treatment time,and the trajectory length per unite time in the BTX-A group was statistically lower th an th at in the routine g roup(F=7.449,P<0.001).(6)The center of gravity swing range(front and back)difference of the routine group and BTX-A group at different time points were statistically significant(F=366.612,P<0.001),the center of gravity swing range(front and back)in the two groups reduced with the prolonging of treatment time,and the center of gravity swing range(front and back)in the BTX-A group was statistically lower than that in the routine group(F=7.431,P=0.010).(7)The center of gravity swing area per unite time difference of the routine group and BTX-A group at different time points were statistically significant(F=256.036,P<0.001),the center of gravity swing area per unite time in the two groups reduced with the prolonging of treatment time,and the center of gravity swing area per unite time in the BTX-A group was statistically lower than that in the routine group(F=6.963,P=0.010).(8)The adverse reaction in group BTX-A: one case appeared red spots rash(2.8%),other adverse reactions did not occur.Conclusion:BTX-A injection combined with rehabilitation training can significantly improve the balance function of children with cerebral palsy(spastic hemiplegia),and BTX-A injection was safety.