本研究目的在探討肉毒桿菌素（Botulinum Toxin type A即BTX-A）注射後物理治療的介入對下肢痙攣型腦性麻痺兒童動作控制之成效，並希望藉此建立一套物理治療計畫之指標。14位下肢痙攣型腦性麻痺兒童，年齡為2至8歲，其中5位兒童在接受肉毒桿菌素注射後馬上進行物理治療，5位在肉毒桿菌素注射後延遲10天才進行物理治療，另外4位在肉毒桿菌素注射後，僅接受簡易居家訓練。物理治療介入每週3~4次，共3個月，以被動關節活動度、肌肉張力（調整式Ashworth量表）、選擇性動作控制（Selective motor control）、肌肉力量、步態（觀察式步態量表（Observation gait scales））、粗動作功能（粗大動作功能量表（GMFM）），做為療效的指標。包括前測二個月的三次基準點評量及肉毒桿菌素注射後第十天的第一次後測評量，以及後續每隔一個月的後測評量，共完成七次評估；結果顯示肉毒桿菌素注射後，能增加被動關節活動度、降低肌肉張力（p＜0.05）；但選擇性動作控制、肌肉力量、步態、動作功能，則在肉毒桿菌素注射後物理治療介入（E5-E7）才有顯著差異（p＜0.05）。結論與建議：本研究顯示雖然注射肉毒桿菌素對於降低痙攣、增加被動關節活動度有效果，但對於選擇性動作控制、肌肉力量、步態、動作功能的改善則需接受物理治療。本研究物理治療計畫內容及設計理念，可作為小兒物理治療師在臨床治療主要參考模式。本研究有部分限制，如樣本數太少、無法完全隨意分配受試者；再者選擇適合極幼小受試者的評估工具也是一大挑戰。建議後續研究除了增加受試者外，並希望有較客觀且適合幼小受試者的量化評估工具。

　　The purposes of the study were to 1) investigate the influence of physical therapy on the motor control in children with spastic diplegic cerebral palsy after botulinum toxin A (BTX-A) injections; 2) develop and establish a standard protocol of physical therapy program (PT) for children after BTX-A injection. Fourteen children with spastic diplegic cerebral palsy (2 to 8 years old) participated this study and were divided into three groups with three treatment conditions (immediate PT, delay PT and no PT). There were 2 month baseline phase before BTX-A injection. After BTX-A injection, PT treatment either started immediately, started delay 10 days or did not started at all. PT was provided to the children 3-4 times a week, for a total of 3 months. Outcome measures included passive range of motion (PROM), modified Ashworth scale, muscles strength and selective motor control (SMC), gait analysis and gross motor functional measure (GMFM). The outcomes were measured seven times: 3 during the baseline phase before BTX-A injection, one at 10 days after injection and then 3 at an interval of one month after injection. The results presented that there were significant decrease of muscle tone and increase in PROM in all groups (p<.05). Other functional status including SMC, gait scores and GMFM scores (p<.05) only improved in the groups of BTX-A injection plus PT intervention (immediate PT and delay PT) but not the no-PT group. The results demonstrated that PT was significant in improving the motor control in children with cerebral palsy after BTX-A injection. The content and concept of PT designed in this study could be used as a guideline for management of cerebral palsy after BTX-A injection. However, due to small sample size and a lack of randomization for grouping, the generalization of the results of the study should be cautious.

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