Improvement of spinal sensorimotor adaptation in children with cerebral palsy with various locomotor patterns using botulinum therapy and compression orthoses

At the core of any rhythmic movement, including walking, lies the function of Central Pattern Generators (CPGs) - neuronal circuits in the spinal cord. Spastic forms of cerebral palsy (CP) hinder full locomotion. CPGs, in the absence of supraspinal control, can generate locomotor patterns independently, which can affect the ability to move both positively and negatively. In rehabilitation, we aim to increase the afferent flow of impulses in patients with CP, which is possible when combining botulinum toxin therapy and providing patients with compressive orthoses. These orthoses can improve the performance of motor tasks in children with CP. Walking, running, and swimming lead to rhythmic arm movements along with the legs through coordination between the central pattern generators of the upper and lower extremities. The absence of coordination or increased spasticity in the upper and lower extremities can be the cause of activation of pathological motor patterns. Thus, spinal cord neuronal circuits become generators of pathologically increased excitation, shaped as a result of a focal organic lesion of the central nervous system. Injections of Botulinum Toxin A (BTX-A) in the upper extremity allow modifying the formation of dominant synergy. Wearing compressive orthoses (corsets, leggings, or long-sleeved shirts) helps create the correct locomotion. Based on the analysis of modern research, a range of botulinum toxins has registered an effective and favorable safety profile for BTX-A (incobotulinumtoxin A) use in children with CP. The combination of botulinum toxin therapy, orthoses, and physical therapy is a dominant factor in rehabilitation.