The goal of Grandview’s Orthopaedic Clinic is to provide orthopaedic consultation and post-surgical follow-up for the clients of Grandview Children’s Centre and Five Counties Children’s Centre. Included in this partnership is the services of a paediatric orthopaedic surgeon from The Hospital for Sick Children (SickKids), medical staff from Grandview, and the client’s physiotherapists and/or occupational therapists from Grandview and Five Counties.
Referrals to the clinic are made on behalf of the client by Grandview medical staff in collaboration with the child’s physiotherapist or occupational therapist.
The orthopaedic surgeon comes to Grandview’s Oshawa site several times per year to provide consultation to clients who have cerebral palsy. Through the use of clinical and x-ray examinations, the surgeon monitors the position of the client’s spine, hips and legs.
If necessary, surgery may be recommended to correct alignment of the bones. This surgery is usually conducted at SickKids in Toronto. After surgery, the surgeon provides the family, Grandview or Five Counties, and other community partners involved with the child with a plan of care to support the child’s recovery.
Muscle Tone (Botox) Clinic
The Muscle Tone (Botox®) Clinic was established at Grandview to evaluate children for treatment of spasticity caused by cerebral palsy and similar disorders through the use of Botulinum A (trade name Botox®) injections. Because Botox® is an injected medicine, it is natural for parents to want to know more about it. The decision to start treatment with Botulinum A is an important one, and parents often have questions.
In the sections below, we answer some of the most commonly-asked questions about Botulinum A. Please read through the information below and be sure to ask your child’s therapist or physician at Grandview if you have questions. We are here to help you make the best decision for your child.
Botulinum Toxin (Botulinum A) is one of a number of toxins produced by the bacterium Clostridium Botulinum. In small amounts, the purified toxin can be beneficial in the treatment of muscle spasticity for neurological disorders such as cerebral palsy. Most people are familiar with the term “Botulism”… in large amounts this toxin can cause severe food poisoning and in young babies, muscle paralysis. However, it is these same properties that allow it to be used as an effective treatment for children with cerebral palsy.
Botox® works by blocking the connection between nerves and muscles. This causes temporary decreases in muscle tone which can last for 3 to 6 months.
Some of the symptoms of cerebral palsy are due to spasticity. Spastic muscles have difficulty relaxing. When a normal muscle is active or working, it contracts or shortens; when it is resting or inactive, it relaxes to its original length. In cerebral palsy, muscles that are spastic do not relax to their full length at rest. Prolonged spasticity often leads to permanent muscle shortening (contractures). Over time, this may lead to bone and joint deformities which make it harder for clients to use their limbs. Much of the treatment for cerebral palsy is directed at minimizing the effects of spasticity on muscle function and growth. When we use Botox® we hope that by reducing spasticity we will:
- Promote more normal muscle growth.
- Avoid or postpone the need for surgery.
- Improve range of motion.
- Improve the client’s functional abilities.
The success of this treatment depends on many factors, most importantly the therapy that follows the injections. Botox® works to relax the muscle and provides a window of opportunity to improve function. If Botox® is given without stretching or retraining, the child will continue to use his/her habitual pattern and little may be gained during this time. Currently, Grandview Children’s Centre is participating in a research study that is looking at the long term benefits of Botox® on walking and motor function. We look forward to seeing the results of this study in the near future.
If a muscle is already lacking range, therapy and positioning devices such as orthotics and serial casting may be used to gradually stretch the muscle. Muscles on both sides of the joint would then need to be strengthened to improve control and function through the newly gained range.
Most children who attend the Muscle Tone (Botox®) Clinic have cerebral palsy, and have spasticity (tightness) in their muscles. Sometimes children with acquired brain injuries and spinal cord injuries come to the clinic as well. Botox® is most effective for children who have moderate spasticity in 1-2 limbs and don’t have “fixed” muscle shortening. If the muscle shortening has become “fixed”, the children will be seen in our Orthopaedic clinic, but many children are seen in both clinics. However, children with early fixed muscle contractures may benefit from a combination of Botox® and splinting or serial casting.
There is evidence that younger children (aged 2 to 7 years) may benefit more from Botox® than other children. However, older children may also receive some benefit.
Botox® has been proven to be a very safe drug. Although the injection is painful, the discomfort lasts for under 1 minute. Many clients have no side effects; however, some experience:
- mild fever which occurs 1-2 days after the injection
- swelling or redness at the injection site
- rarely, generalized muscle weakness and fatigue
Your team in the Muscle Tone (Botox®) Clinic will take the time to go through benefits and side effects, so be sure to bring your questions to these appointments!
The Muscle Tone (Botox®) Clinic is held weekly on Wednesday mornings at the main site of Grandview Children’s Centre in Oshawa (located at 600 Townline Road South). Dr. Mark Mason is our consulting physiatrist. He is a specialist in rehabilitation medicine, and has run the Muscle Tone (Botox®) Clinic for Grandview Kids for more than 10 years. Dr. Mason will complete your child’s assessment, along with information from your child’s therapy team. Together you will decide if the injections are right for your child. Ongoing follow-up is provided through this clinic.
Botox® is injected into muscles in the arms or legs. The dose of Botox® is calculated based on body weight.
The effects of Botox® are seen within 2-5 days, and peak within 2 weeks. You should notice that it is easier to move the affected part of the body.
The effects of Botox® generally last for 3 months. Functional changes achieved during those 3 months may last longer. Your child’s therapist will help you monitor the effect and refer your child for re-injection, if required.
There is a significant cost for the Botox® drug, which is not covered by Grandview Children’s Centre. Many families have coverage through their private insurance benefits. Our Social Work Services team is available to assist families to secure funding if needed.