Tone Reduction and Physical Therapy: Strengthening Partners in Treatment of Children with Spastic Cerebral Palsy

Inge Franki; Lynn Bar-On; Guy Molenaers; Anja Van Campenhout; Karen Craenen; Kaat Desloovere; Hilde Feys; Petra Pauwels; Jos De Cat; Els Ortibus

doi:10.1055/s-0039-3400987

Neuropediatrics, Table of Contents

Neuropediatrics 2020; 51(02): 089-104
DOI: 10.1055/s-0039-3400987

Review Article

Georg Thieme Verlag KG Stuttgart · New York

Tone Reduction and Physical Therapy: Strengthening Partners in Treatment of Children with Spastic Cerebral Palsy

Inge Franki

¹Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium

²Cerebral Palsy Clinic, University Hospitals Leuven—Campus Pellenberg, Leuven, Belgium

,

Lynn Bar-On

³Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium

,

Guy Molenaers

¹Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium

⁴Clinical Motion Analysis Laboratory, University Hospitals Leuven—Campus Pellenberg, Leuven, Belgium

⁵Department of Orthopedics, University Hospital Leuven, Leuven, Belgium

,

Anja Van Campenhout

¹Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium

⁴Clinical Motion Analysis Laboratory, University Hospitals Leuven—Campus Pellenberg, Leuven, Belgium

⁵Department of Orthopedics, University Hospital Leuven, Leuven, Belgium

,

Karen Craenen

²Cerebral Palsy Clinic, University Hospitals Leuven—Campus Pellenberg, Leuven, Belgium

,

Kaat Desloovere

³Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium

⁴Clinical Motion Analysis Laboratory, University Hospitals Leuven—Campus Pellenberg, Leuven, Belgium

,

Hilde Feys

³Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium

,

Petra Pauwels

²Cerebral Palsy Clinic, University Hospitals Leuven—Campus Pellenberg, Leuven, Belgium

,

Jos De Cat

²Cerebral Palsy Clinic, University Hospitals Leuven—Campus Pellenberg, Leuven, Belgium

,

Els Ortibus

¹Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium

²Cerebral Palsy Clinic, University Hospitals Leuven—Campus Pellenberg, Leuven, Belgium

⁶Centre for Developmental Disabilities, Leuven, Belgium

› Author Affiliations

Abstract

The aim of this paper is to provide a clinically applicable overview of different tone reducing modalities and how these can interact with or augment concurrent physical therapy (PT). Botulinum toxin (BoNT), oral tone-regulating medication, intrathecal baclofen (ITB), and selective dorsal rhizotomy are discussed within a physiotherapeutic context and in view of current scientific evidence. We propose clinical reasoning strategies to identify treatment goals as well as the appropriate and corresponding treatment interventions. Instrumented measurement of spasticity, standardized clinical assessment, and 3D clinical motion analysis are scientifically sound tools to help select the appropriate treatment and, when needed, to selectively target or spare individual muscles. In addition, particular attention is given to strength training as a necessary tool to tackle muscle weakness associated with specific modalities of tone reduction. More research is needed to methodologically assess the long-term effectiveness of such individualized tone treatment, optimize parameters such as medication dosage, and gain more insight into the kind of PT techniques that are essential in conjunction with tone reduction.

Keywords

cerebral palsy - tone reduction - spasticity - physical therapy

Full Text

References

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