title: Effect of multilevel botulinum toxin a and comprehensive rehabilitation on gait in cerebral palsy.
abstract: To evaluate the effect of multilevel botulinum toxin A and comprehensive rehabilitation on gait pattern, muscle length, and spasticity, a multicenter randomized trial was performed in 46 children with spastic cerebral palsy who walk with flexed knees. Their mean age was 8.0 years (range 4 to 11 years). They were randomly allocated to the intervention group (multilevel botulinum toxin A and comprehensive rehabilitation) or the control group (usual care). After 6 weeks, a significant treatment effect in the intervention group was observed on: improved knee extension during midstance and terminal swing (7 degrees and 5 degrees , P < 0.01, respectively); hip rotation during terminal swing (4 degrees , P = 0.02); gait score (1.7, P < 0.01); decreased spasticity in hamstrings (11 degrees , P < 0.01), gastrocnemius (6 degrees , P = 0.01), and soleus (5 degrees , P = 0.02); and increased muscle length in hamstrings (9 degrees , P < 0.01) and gastrocnemius (5 degrees , P < 0.01). The improved muscle length was maintained up to 24 weeks. This study demonstrated that multilevel botulinum toxin A and comprehensive rehabilitation improves knee extension during gait, increases muscle length, and decreases spasticity in injected muscles after 6 weeks in children who walk with flexed knees. Although the effect on muscle length was maintained after 24 weeks, the effect on gait and spasticity had disappeared.
authors.affiliation: Department of Rehabilitation Medicine and Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands. vab.scholtes@vumc.nl <vab.scholtes@vumc.nl>
authors.forename: Vanessa A
authors.initials: VA
authors.lastname: Scholtes
authors.forename: Annet J
authors.initials: AJ
authors.lastname: Dallmeijer
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Knol
authors.forename: Lucianne A
authors.initials: LA
authors.lastname: Speth
authors.forename: Carel G
authors.initials: CG
authors.lastname: Maathuis
authors.forename: Peter H
authors.initials: PH
authors.lastname: Jongerius
authors.forename: Jules G
authors.initials: JG
authors.lastname: Becher
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005684:Gait / Q000187:drug effects*; D020233:Gait Disorders, Neurologic / Q000188:drug therapy / Q000534:rehabilitation; D006801:Humans; D007719:Knee Joint; D008297:Male; D009119:Muscle Contraction / Q000187:drug effects; D009128:Muscle Spasticity / Q000188:drug therapy / Q000534:rehabilitation; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A