• Flaminia Frascarelli, Lorenzo Masia, Giuseppe Di Rosa, Maurizio Petrarca, Paolo Cappa, and Enrico Castelli.
• Pediatric Neuro-Rehabilitation Division, Children's Hospital Bambino Gesù IRCCS Via Torre di Palidoro, IT-00050 Passoscuro (Fiumicino) Rome, Italy. flaminiafrascarelli@opbg.net
• J Rehabil Med. 2009 Nov 1; 41 (12): 988-94.

ObjectiveThe aim of this pilot study was to examine changes in different aspects of impairment, including spasticity in the upper limbs, of hemiplegic children following botulinum toxin type A intervention. Progress was assessed using standard clinical measurements and a robotic device.DesignPre-post multiple baseline.SubjectsSix children with hemiplegia.MethodsBotulinium toxin type A injections were administered into the affected upper limb muscles. Outcomes were evaluated before and one month after the injection. Outcome assessments included: Melbourne Scale, Modified Ashworth Scale (MAS) and Passive Range of Motion. Furthermore, a robotic device was employed as an evaluation tool.ResultsPatients treated with botulinum toxin type A had significantly greater reduction in spasticity (MAS, p < 0.01), which explains an improvement in upper limb function and quality movement measured with the Melbourne Scale (p < 0.01). These improvements are consistent with robot-based evaluation results that showed statistically significant changes (p < 0.01) following botulinum toxin type A injections.ConclusionThe upper limb performs a wide variety of movements. The multi-joint nature of the task during the robot-mediated evaluation required active control of joint interaction forces. There was good correlation between clinical scales and robotic evaluation. Hence the robot-mediated assessment may be used as an additional tool to quantify the degree of motor improvement after botulinum toxin type A injections.

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