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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
1   Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
2   Cerebral Palsy Clinic, University Hospitals Leuven—Campus Pellenberg, Leuven, Belgium
,
Lynn Bar-On
3   Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
,
Guy Molenaers
1   Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
4   Clinical Motion Analysis Laboratory, University Hospitals Leuven—Campus Pellenberg, Leuven, Belgium
5   Department of Orthopedics, University Hospital Leuven, Leuven, Belgium
,
Anja Van Campenhout
1   Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
4   Clinical Motion Analysis Laboratory, University Hospitals Leuven—Campus Pellenberg, Leuven, Belgium
5   Department of Orthopedics, University Hospital Leuven, Leuven, Belgium
,
Karen Craenen
2   Cerebral Palsy Clinic, University Hospitals Leuven—Campus Pellenberg, Leuven, Belgium
,
Kaat Desloovere
3   Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
4   Clinical Motion Analysis Laboratory, University Hospitals Leuven—Campus Pellenberg, Leuven, Belgium
,
Hilde Feys
3   Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
,
Petra Pauwels
2   Cerebral Palsy Clinic, University Hospitals Leuven—Campus Pellenberg, Leuven, Belgium
,
Jos De Cat
2   Cerebral Palsy Clinic, University Hospitals Leuven—Campus Pellenberg, Leuven, Belgium
,
Els Ortibus
1   Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
2   Cerebral Palsy Clinic, University Hospitals Leuven—Campus Pellenberg, Leuven, Belgium
6   Centre for Developmental Disabilities, Leuven, Belgium
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Publikationsverlauf

30. April 2019

16. Oktober 2019

Publikationsdatum:
27. November 2019 (online)

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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