Use of the Quality Function Measure to Evaluate Changes in the Quality of Movement in Ambulant Children with Cerebral Palsy following Lower Limb Botulinum Toxin A (Bont-A) Injections

Katchburian Lesley
Great Ormond Street Hospital for Children NHS Foundation Trust, London

Quality of movement (QOM) is an essential component of effective motor skills in children with cerebral palsy (CP) which influences both activity and participation opportunities.
Botulinum neurotoxin A (BoNT-A) aims to optimize a child's functional skills and improve QOM. Evidence associating reduction in dynamic spasticity and QOM improvement is lacking with a demand for more sensitive outcome measures to evaluate efficacy of BoNT-A.
The feasibility of introducing the Quality Function Measure (QFM) into an established clinical setting was evaluated to assess short-term change in QOM. In total, 55 ambulant children with CP were recruited (Gross Motor Function Classification System [GMFCS] levels: I=20, II=21, III=14; mean age 7y 4mo [SD 2y 8mo]). Experienced physiotherapists
administered the QFM pre-injection and 6 weeks post-injection following a standardized protocol to capture performance from frontal and coronal planes of movement. Mean time to perform the test was 39 minutes (range 25–60mins). This differed between GMFCS levels; level I=28 minutes (SD 2.4mins), II=37 minutes (SD 6.8mins), III= 51.8 minutes (SD 8mins).
Children in GMFCS level III completed fewer test items but took longer to complete the tests and exhibited increasing fatigue. Initial results suggest that improvement in QOM is seen with short term reduction in dynamic spasticity following BoNT-A. QFM administration in the clinical setting (39mins) compares to other standardized tests requiring post-clinic evaluation. Introduction of QFM has proved acceptable in an established clinical setting, providing clinic times are extended to accommodate this. However it remains to be seen whether timing of post-clinic analysis prohibits its use in a clinical setting..

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