Gait Rehabilitation in Ambulant Diplegic Children Using Botulinum A Injection and Ankle Weights

Abstract

Objectives. Standing and walking serve an individual’s basic needs to move from place to place, and both are the most common activities that people do daily. So, this study aims to investigate the combined effect of botulinum A injection and ankle weight on excessive knee flexion in diplegic children with crouch gait. Methods. Sixty children with spastic diplegia walking with a crouch gait were included in this study. They were divided equally into three groups (twenty in each): group A received classical gait rehabilitation, group B received the same gait training while adding ankle weights, and group C received the same as group A and B plus botulinum A injection. The modified Ashworth scale (MAS) and Hoffman reflex/Myogenic response (H/M ratio) were used to evaluate the spasticity of the hamstring and gastrocnemius muscles, while two-dimension gait analysis was used to record knee flexion angles during gait. The assessment was held one day before starting the treatment and after completing three months of the treatment program. Results. There was no significant difference between groups before treatment regarding all measured variables. group A revealed a statistically nonsignificant improvement after treatment. Patients in group B showed significant improvement after treatment for both knees regarding the H/M ratio and MAS, which was reflected in the right and left knee range of motion at initial contact ( P values 0.030 and 0.001, respectively) and midstance ( P values 0.030 and 0.006, respectively). However, more significant improvement was detected regarding all studied variables in both knees after treatment in group C patients with a P value <0.001. Conclusion. The combination of botulinum A injection and ankle weights was more effective in controlling excessive knee flexion in diplegic children with a crouch gait.