Family-centred, goal-directed multidisciplinary approach for lower extremity botulinum toxin with physical therapy and rehabilitation in cerebral palsy

Abstract

Purpose: This study aimed to investigate lower extremity botulinum toxin (BT) and physical therapy and rehabilitation (PTR) application scoping "family-centered, goal-directed multidisciplinary approach (FGMA)" in the children with cerebral palsy (CP) and to assess the satisfaction of parents and children from this approach. Methods: A physician and physiotherapist evaluated 30 children (age=6.33±2.38 years) with ambulatory CP and their parents using the FGMA. Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) were used to define the functionality of children. Selectivity was assessed using the Selective Control Assessment of the Lower Extremity (SCALE). Walking was evaluated using the Observational Gait Scale (OGS) and the Gillette Functional Assessment Questionnaire (FAQ). Satisfaction levels marked on the Visual Analogue Scale. Results: Nineteen (63%) children were GMFCS level III, 16 (53%) children were MACS level I, 19 (63.33%) children were CFCS level I. Half of children had visual problems. While the most preferred muscles were hamstring and gastrocnemius for BT, the most common device was ankle-foot orthosis. The median score of SCALE, OGS, and FAQ, and the satisfaction of parents and children were 8 (4-17), 12 (2-24), 2 (1-10), 9 (7-10), and 7 (6-10) points, respectively. The satisfaction level of parents with the new approach was higher than the previous traditional approach (p<0.001). Conclusions: Both the parents and children may be satisfied with the FGMA for BT with the PTR program. Clinicians should take into account lower extremity selectivity, walking performance, and satisfaction levels as much as muscle tone or range of motion.