ROBOT-MEDIATED AND CLINICAL SCALES EVALUATION AFTER UPPER LIMB BOTULINUM TOXIN TYPE A INJECTION IN CHILDREN WITH HEMIPLEGIA

Objective: The 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. Design: Pre-post multiple baseline. Subjects: Six children with hemiplegia. Methods: Botulinium 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. Results: Patients 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. Conclusion: The upper limb performs a wide variety of movements. The mufti-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.