Does Reducing Spasticity Permit an Increase in Strength?
Status:
Completed
Trial end date:
2006-04-01
Target enrollment:
Participant gender:
Summary
Reduction of spasticity has been a major focus of the treatment of childhood cerebral palsy,
resulting in numerous treatment strategies that target various parts of the motor system.
However, in many children weakness may be a greater contributor to disability than
spasticity. Recent results suggest a correlation between spasticity and weakness, but it is
not known if reduction of spasticity can improve strength.
We suggest a simplified model in which spinal mechanisms (including reflex contributions to
spasticity) and supraspinal mechanisms (including voluntary contributions to strength)
combine to activate muscle. The model implies that the supraspinal contribution cannot
increase unless the spinal contribution decreases. We therefore hypothesize that reduction of
spasticity improves the ability to increase voluntary strength.
We propose a double-masked placebo-controlled clinical trial combining treatment using the
oral anti-spasticity medication baclofen with a 6-week program of strength training. We will
enroll 20 ambulatory children with spastic diplegic cerebral palsy. Prior to and following
the intervention, we will obtain quantitative measures of spasticity, strength, and gait. We
predict that the children taking baclofen will have a greater increase in strength than the
children taking placebo. We predict that the increase in strength will be reflected in
improved performance on gait analysis, and it will correlate with a reduction in quantitative
measures of spasticity and spinal reflex excitability.
If the hypothesis is correct, it will provide important new information on the relationship
between spasticity and strength in children with cerebral palsy. It will provide the first
measurements of the effect of baclofen on voluntary muscle activation in children. It will
support the short-term use of combined anti-spasticity medication and strengthening as a new
clinical treatment for ankle weakness in children with spastic diplegia. A successful result
will have immediate and significant implications for treatment of children with cerebral
palsy.