Assessment protocol for serial casting after botulinum toxin a injections to treat equinus gait.
OBJECTIVE
The purpose of this study was to investigate feasibility of an assessment protocol for a trial of post-Botox casting to treat equinus gait in cerebral palsy.


METHODS
Ten children (ages, 26-75 months) were recruited. Nine were assessed 1 week before botulinum toxin-A injections and reassessed 1 week after removal of the final cast. The assessment protocol included Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), Gross Motor Function Measure-66 (GMFM-66), Pediatric Evaluation of Disability Inventory (PEDI), and GAITRite. Feasibility was based on acceptability of the protocol, inter-rater reliability, and responsiveness of outcome measures.


RESULTS
The assessment protocol was acceptable and practical. Inter-rater reliability for MAS, MTS, and GMFM ranged from moderate to excellent. Improvements were found in MTS and MAS scores for dorsiflexion and hamstring (p < 0.01), GMFM-66 (p = 0.01), and Pediatric Evaluation of Disability Inventory mobility (p = 0.01), self-care (p = 0.01), and social function (p = 0.00). GAITRite revealed reductions in speed (p = 0.00) and cadence (p = 0.01).


CONCLUSIONS
Feasibility was confirmed. Recommendations include raising minimum age and delaying gait analysis.
Kelly
Barbara
B
School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada. barbara.kelly@iwk.nshealth.ca
MacKay-Lyons
Marilyn J
MJ
Berryman
Susan
S
Hyndman
Joe
J
Wood
Ellen
E
D001905:Botulinum Toxins / Q000008:administration & dosage* / Q000009:adverse effects; D002370:Casts, Surgical; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004185:Disability Evaluation; D004863:Equinus Deformity / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005684:Gait / Q000187:drug effects* / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D009122:Muscle Hypertonia / Q000139:chemically induced; D010865:Pilot Projects; D015203:Reproducibility of Results; D013997:Time Factors
D001905:Botulinum Toxins