Which muscle groups are commonly targeted with botulinum toxin injections to improve gait in spastic CP?

Which muscle groups are commonly targeted with botulinum toxin injections to improve gait in spastic CP?

• A. Hamstrings, gastrocnemius-soleus, hip adductors, hip flexors.
• B. Deltoids and trapezius.
• C. Quadriceps only.
• D. Abdominals and back extensors.

Answer: (A)

Targeting focal spasticity in muscles that directly disrupt gait allows the limb to move more normally during walking. In spastic cerebral palsy, the hamstrings, gastrocnemius-soleus complex, hip adductors, and hip flexors are commonly overactive and pull joints into positions that hinder walking. Reducing tone in these groups with botulinum toxin can improve knee extension in stance (by relaxing the hamstrings when they pull the knee into flexion), enable better ankle dorsiflexion during the swing phase (by dampening plantarflexor activity), lessen hip adduction that causes scissoring or midline narrowing, and reduce excessive hip flexion that keeps the leg in a flexed position. This combination specifically addresses the major gait deviations seen in many individuals with spastic CP, making it the most effective target set for improving walking. The other options involve muscles that have less impact on primary gait deviations in CP—shoulder and neck muscles for upper limb function, core muscles for posture rather than walking mechanics, and the quadriceps alone don’t address the common pattern of ankle plantarflexor, hip adductor, and hamstring overactivity central to walking difficulties.

Targeting focal spasticity in muscles that directly disrupt gait allows the limb to move more normally during walking. In spastic cerebral palsy, the hamstrings, gastrocnemius-soleus complex, hip adductors, and hip flexors are commonly overactive and pull joints into positions that hinder walking. Reducing tone in these groups with botulinum toxin can improve knee extension in stance (by relaxing the hamstrings when they pull the knee into flexion), enable better ankle dorsiflexion during the swing phase (by dampening plantarflexor activity), lessen hip adduction that causes scissoring or midline narrowing, and reduce excessive hip flexion that keeps the leg in a flexed position. This combination specifically addresses the major gait deviations seen in many individuals with spastic CP, making it the most effective target set for improving walking.

The other options involve muscles that have less impact on primary gait deviations in CP—shoulder and neck muscles for upper limb function, core muscles for posture rather than walking mechanics, and the quadriceps alone don’t address the common pattern of ankle plantarflexor, hip adductor, and hamstring overactivity central to walking difficulties.