Nerve and Muscle Blocks

A. Botox Injections (Botulinum type A toxin)
 

Children who benefit most from Botox are those who are too young for surgery or for whom
surgery is not yet warranted. Botox injections can provide an opportunity to evaluate the child’s
readiness for more permanent orthopedic procedures. In some cases, injections can provide
enough spasticity control that surgery can be avoided.

Botox injections can help improve a child’s ability to walk or use their hands and allow for a
better fitting orthotics by reducing spasticity. Therapists can take advantage of the time when an
overly powerful muscle is weakened to work on strengthening the muscle on the opposite side of
the joint (antagonist). Sometimes, casting of the involved extremity is done after the injection to
increase the stretch of the tight muscle.
 

When injected into the muscle, Botox interferes with the release of a chemical, acetylcholine, at
the junction of the muscle and nerve. This partially interrupts muscle contraction making the
muscle temporarily weaker. This becomes evident two to ten days after treatment and lasts
approximately 3 to 6 months.

Botox is currently being used to treat spasticity due to multiple sclerosis, head injury, stroke and
spinal cord injury. It has been used to relieve movement disorders of the head and neck, such as
torticollis. Most recently, botulinum toxin has been used successfully to treat spasticity in
children due to the muscle imbalances caused by cerebral palsy. “Dynamic deformities”
unresponsive to other treatments, may improve following Botox, delaying or preventing the need
for surgery or orthotics.

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