Grant: Collaborative Health Research Projects (NSERC partnered)

Background: Cerebral Palsy (CP) is an umbrella term designating a group of non-progressive neurological disorders. One common treatment in CP is chemical denervation of spastic muscles using botulinum toxin type-A (BTXA). However, in pilot work we demonstrated that BTXA injections cause atrophy, fat invasion and loss of structural integrity in target and non-target muscles, thereby severely compromising the strength and function of these muscles. We hypothesize that much of the deterioration of BTXA-injected muscles could be prevented with direct electrical stimulation of the target muscles. Objectives: The primary purpose of this project is to test the hypothesis that direct muscle stimulation training prevents BTXA-induced muscle atrophy, fat invasion and structural degeneration of target and non-target muscles in patients with CP and in a rabbit model of BTXA injections. A secondary purpose is to develop a small and easy to operate functional muscle stimulation unit for safe use by patients at home. Scientific Approach: This study consists of three parts: (i) a controlled animal study of BTXA injections with and without direct muscle stimulation training; (ii) a clinical study with CP patients receiving/not receiving direct muscle stimulation training during the BTXA intervention period; and (iii) a design study aimed at developing a cheap, safe and easy to use direct muscle stimulation device for training at home. Significance: BTXA treatments are a frequently used modality to chemically ablate muscles in CP patients to restore joint excursion and function. Following BTXA treatment, muscles should be strong and allow for mobility and improved functionality. However, this is not the case, because of the loss of strength and structural integrity of the target musculature. Here, we will test an approach that will retain all advantages of the BTXA treatment while simultaneously protect the target muscles thus provide for a better patient outcome. If successful, the results of this study will have a direct and profound impact on BTXA treatments in CP patients.