Hypertonia Clinic

Botulinum Toxin is one of several toxins produced by the bacterium Clostridium Botulinum. In small amounts, the purified toxin can be beneficial in treating muscle spasticity or dystonia for neurological disorders such as cerebral palsy. Most people are familiar with the term “Botulism,” and in large amounts, this toxin can cause severe food poisoning and, in young babies, muscle paralysis. However, it is these same properties that make it an effective treatment for children with cerebral palsy.

Botulinum Toxin works by blocking the connection between nerves and muscles. This causes temporary decreases in muscle tone. The effects of Botulinum Toxin are seen within 2-5 days and peak within two weeks. You should notice that it is easier to move the affected part of the body. The effects of Botulinum Toxin generally last for 3 months. Functional changes achieved during those three months may last longer. Your child’s therapist will help you monitor the effect.

Some of the symptoms of cerebral palsy are due to increased muscle tone. Muscles with increased tone 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 have increased tone do not relax to their full length at rest. Prolonged hypertonia 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 hypertonia on muscle function and growth. When we use Botulinum Toxin, we hope that by reducing tone, we will: 

The success of this treatment depends on many factors, most importantly, the therapy that follows the injections. Botulinum Toxin works to relax the muscle and provide a window of opportunity to improve function. If Botulinum Toxin is given without stretching or retraining, the child will continue to use his/her habitual pattern, and little may be gained during this time.  

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 Hypertonia Clinic have cerebral palsy and have increased tone (tightness) in their muscles. Sometimes children with acquired brain injuries and spinal cord injuries come to the clinic as well. Botulinum Toxin is most effective for children who don’t have “fixed” muscle shortening. If the muscle shortening has become “fixed,” the children may 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 Botulinum Toxin and splinting or serial casting. 

There is evidence that younger children (aged 2 to 7 years) may benefit more from Botulinum Toxin than other children. However, older children may also receive benefit. 

Botulinum Toxin 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: 

Your team in the Hypertonia Clinic will take the time to go through benefits and side effects, so be sure to bring your questions to these appointments! 

Botulinum Toxin is injected into muscles in the arms or legs. The dose of is calculated based on body weight. An ultrasound machine is used to find the correct muscle.

The team uses a variety of strategies to reduce the discomfort as much as possible during the injection procedure. Topical analgesia is used by either applying freezing spray and/or placing ice packs on the injection sites. Parents and caregivers can assist by providing reassurance and supporting opportunities for distraction during the procedure. 

The clinic has many toys and sensory gadgets to help with distraction that clients can choose from. Comfort items from home are always welcome. Clients can also choose to be part of our “Courage Beads” program, where they receive various beads for their bravery. Please ask us more about the Courage Beads program when you visit us for your appointment. 

Sedation clinics are held three times a year at Lakeridge Health in Oshawa, where your child may attend to receive injections under general anesthesia. Please speak with your physician in the Hypertonia Clinic to determine if this is an appropriate option for your child.

Your child can return to school and regular activities immediately after injections. We recommend avoiding strenuous activities for 24 hours and avoiding any massage to the area for 48 hours.

There is a significant cost for the Botulinum Toxin drug, which Grandview Kids does not cover. Many families have coverage through OHIP+ or their private insurance benefits. Our Social Work team is available to assist families with sourcing and/or securing funding, if needed.

The Hypertonia Clinic is held weekly on Wednesdays at Grandview Kids – The Jerry Coughlan Building in Ajax (1461 Harwood Ave North, Ajax, ON L1T 0R3). Dr. Mark Mason (physiatrist) and Dr. Nikki Fischer (developmental paediatrician) are our consulting physicians, along with our registered nurse and clinic therapist.

Dr. Mason or Dr. Fischer 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.

If you have additional questions regarding Botulinum Toxin or are interested in discussing a clinic referral please contact your child’s physiotherapist, occupational therapist or physician to discuss your child’s participation in the clinic further.