Cerebral palsy: a rational approach to a treatment protocol, and the role of botulinum toxin in treatment.

Cerebral palsy (CP) is characterized by aberrant control of movement or posture and appears early in life secondary to central nervous system damage. The symptoms of CP fall into four groups: symptoms due to loss of selective motor control; symptoms due to abnormal muscle tone; symptoms due to imbalance between muscle agonists and antagonists; and symptoms due to impaired balance. The goals of treatment are to maximize function and minimize the development of joint contracture and other secondary problems. Development of a treatment plan begins with the definition of objectives and consideration of the effects of growth and development on the patient's abilities. The role of botulinum toxin in CP treatment has grown in recent years. The patient who could benefit most from botulinum toxin treatment is one who is hypertonic and whose abnormal muscle tone is interfering with function, or who is expected to develop joint contracture with growth because of this abnormal tone. By altering this muscle tone, function can be enhanced or additional therapeutic modalities can be employed. Assessing treatment outcomes for BTX injection involves the same set of questions and measurements as for other types of treatments and depends on the careful definition of treatment objectives beforehand.