title: Electrical Stimulation Following Botulinum Toxin A in Children With Spastic Diplegia: A Within-Participant Randomized Pilot Study.
abstract: OBJECTIVE
  To determine whether electrical stimulation (ES) following botulinum toxin A (BoNT/A) injection increases passive extensibility of the hamstring muscles in children with spastic diplegia.
  
  
  METHODS
  Six children undergoing bilateral BoNT/A injections to the hamstrings participated in this within-participant single blind randomized controlled trial. One leg of each child was randomised to the experimental condition and the other to the control condition. The experimental leg received daily stretch and ES to the hamstrings for 12 weeks, while the control leg received only daily stretch. The primary outcome was passive hamstring extensibility reflected by popliteal angle measured with a standardised torque. Secondary outcomes were two goniometric measures of popliteal angle using the Modified Tardieu Scale (R1 and R2), and parents' perceptions of treatment effectiveness. Outcomes were measured at baseline, 4 weeks, 12 weeks and 6 months.
  
  
  RESULTS
  The mean between-group difference (95% CI) at 4 weeks was 2° (-2 to 5) for popliteal angle measured with a standardised torque, favouring the experimental leg. Tardieu results for R1 and R2 were 0° (-4 to 3) and 7° (0 to 14), respectively.
  
  
  CONCLUSIONS
  ES does not improve passive extensibility of the hamstring muscles at 4 weeks over any possible effects of BoNT/A alone.
authors.affiliation: a 1 Physiotherapy Department, Sydney Children's Hospital , Sydney, Australia.
authors.forename: Anita
authors.initials: A
authors.lastname: Mudge
authors.affiliation: b 2 John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School/Northern, University of Sydney , Australia.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Harvey
authors.affiliation: a 1 Physiotherapy Department, Sydney Children's Hospital , Sydney, Australia.|c 3 Cerebral Palsy Service, Sydney Children's Hospital , Sydney, Australia.
authors.forename: Ann
authors.initials: A
authors.lastname: Lancaster
authors.affiliation: c 3 Cerebral Palsy Service, Sydney Children's Hospital , Sydney, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Lowe
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D052580:Muscle Stretching Exercises; D018482:Muscle, Skeletal / Q000503:physiopathology*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010865:Pilot Projects; D016059:Range of Motion, Articular; D016037:Single-Blind Method; D017211:Treatment Failure
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; C545476:incobotulinumtoxinA
keywords: Randomized controlled trials; cerebral palsy; neuromuscular health