Effect of Botulinum Toxin Type A on Motor Function in Children With Cerebral Palsy

The Bilan 400 Points Functional Hand Scale is an assessment tool used to measure hand functionality in patients with neuro-musculoskeletal disabilities. This scale is primarily applied to children and adolescents aged 7 to 17 years and evaluates four key dimensions: hand mobility, grip strength, monomanual grasp and object displacement, and bimanual function. Each of these dimensions is scored out of 100 points, totaling 400 points. The scale is useful for quantifying the degree of use of an injured hand and for objectifying the impact of therapeutic interventions. In the Bilan 400 Points Functional Hand Scale, higher scores (close to 400) indicate good or normal hand functionality, while lower scores (close to 0) reflect very limited or severely impaired functionality.

The GMFM-88 is a standardized tool for assessing changes in gross motor function in children with cerebral palsy. It includes 88 items across five dimensions. Dimensions D and E focus on standing and walking-related tasks. Dimension D evaluates the ability to stand independently, including standing on one leg and transitioning from sitting to standing. Dimension E assesses walking, running, and jumping, such as walking forward, running, and jumping over obstacles. Each item is scored from 0 to 3. Higher scores (close to 100%) indicate better gross motor function and greater independence, while lower scores (close to 0%) reflect significant limitations in performing the evaluated tasks.

The KIDSCREEN-27 is a mid-length questionnaire designed to assess health-related quality of life (HRQoL) in children and adolescents aged 8-18. It includes 27 items across five dimensions: physical well-being, psychological well-being, autonomy and parent relations, social support and peer relations, and school environment. It is ideal when HRQoL is relevant but not the main focus of a study, or when the full version is too long. Each item uses a 5-point Likert scale to measure frequency or intensity of experiences. Responses are converted to scores from 0 (poorest HRQoL) to 100 (best HRQoL). Higher scores indicate better perceived quality of life in each dimension.

The Goal Attainment Scale (GAS) is an individualized assessment tool used to document and score the extent to which a patient achieves their personal goals during an intervention. Each patient sets unique goals, which are formulated using the SMART approach (specific, measurable, achievable, relevant, and time-bound). These goals are rated on a five-point scale: +2 indicates the outcome was much better than expected, +1 somewhat better, 0 exactly as expected, -1 somewhat less than expected, and -2 much worse than expected. This standardized scoring allows for statistical analysis of results and helps tailor interventions to the individual needs of the patient. An average score close to 0 indicates that goals were achieved as planned, while positive values reflect better-than-expected performance and negative values indicate underperformance.

Goniometry is a technique used to measure the range of motion of joints. It is based on measuring joint mobility angles, and its results help identify joint limitations. Ranges of motion are classified as active, passive, or assisted, depending on the degree of patient involvement in the movement. The values obtained are expressed in degrees (°), and each joint has a normal reference range. For example, elbow flexion typically ranges from 0° to 150°. Values within the normal range indicate adequate functional mobility; values below may reflect stiffness, contractures, or limitations, while values above the expected range may suggest hypermobility or joint instability.

The Ashworth Scale is a diagnostic tool used to measure muscle tone in patients with spasticity. It assigns a score from 0 to 4 based on the resistance to passive movement of a joint. The scores are: 0: No increase in muscle tone, 1: Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion, 2: More marked increase in muscle tone through most of the range of motion, but the affected part is easily moved, 3: Considerable increase in muscle tone, passive movement difficult, 4: Affected part rigid in flexion or extension.

The Tardieu Scale is used to assess spasticity in patients with neurological conditions by evaluating muscle response at different stretch speeds and measuring the spasticity angle. It includes two components: the quality of muscle reaction and the angle of reaction. The quality is scored from 0 to 5, where 0 means no resistance, 1 slight resistance, 2 a clear stop with release, 3 a sustained or clonic contraction under 10 seconds, 4 sustained over 10 seconds, and 5 a fixed joint. The angle of reaction (R1) is the point of first resistance during a fast stretch and is compared to the maximum passive range (R2). A greater difference between R2 and R1 indicates more dynamic spasticity, while similar values suggest a fixed contracture.