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Oral Baclofen Increases Maximal Voluntary Neuromuscular Activation of Ankle Plantar Flexors in Children With Spasticity Due to Cerebral Palsy

Department of Neurology and Neurological Sciences, Stanford University Medical Center

Sahana Kukke, MA

Department of Neurology and Neurological Sciences, Stanford University Medical Center

Kevin McGill, PhD

Rehabilitation Research and Development Center, VA Palo Alto Health Care System

Jessica Rose, PhD

Department of Orthopaedic Surgery, Stanford University School of Medicine and Motion & Gait Analysis Laboratory, Lucile Packard Children's Hospital, California

Sara Sherman-Levine, RN, MSN, PNP

Department of Neurology and Neurological Sciences, Stanford University Medical Center

Terence D. Sanger, MD, PhD

Department of Neurology and Neurological Sciences, Stanford University Medical Center, sanger{at}stanford.edu

Although spasticity is a common symptom in children with cerebral palsy, weakness may be a much greater contributor to disability. We explore whether a treatment that reduces spasticity may also have potential benefit for improving strength. Ten children with cerebral palsy and spasticity in the ankle plantar flexor muscles were treated with oral baclofen for 4 weeks. We tested voluntary ability to activate ankle plantar flexor muscles using the ratio of the surface electromyographic signal during isometric maximal voluntary contraction to the M-wave during supramaximal electrical stimulation of the tibial nerve and tested muscle strength using maximal isometric plantar flexion torque. Mean maximal voluntary neuromuscular activation increased from 1.13 ± 1.02 to 1.60 ± 1.30 ( P < .05) after treatment, corresponding to an increase in 9 of 10 subjects. Mean maximal plantar flexion torque did not change. We conjecture that antispasticity agents could facilitate strength training by increasing the ability to voluntarily activate muscle.

Key Words: spasticity • baclofen • neuromuscular activation

This version was published on June 1, 2008

Journal of Child Neurology, Vol. 23, No. 6, 635-639 (2008)
DOI: 10.1177/0883073807313046


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