The Combined Effect of Lower-Limb Multilevel Botulinum Toxin Type A and Comprehensive Rehabilitation on Mobility in Children With Cerebral Palsy: A Randomized Clinical Trial

The use of botulinum toxin A in children with cerebral palsy, with a focus on the lower limb

“…A number of studies emphasise the importance of physical therapy combined with BTX-A treatment [39,[68][69][70][71][72][73][74][75]. Because of the shortage of knowledge on therapy contents and the different outcome measures used in these studies, no consensus can be reached concerning the content of the physiotherapy programme after treatment with BTX-A.…”

“…BTX-A has a variety of short-term successful outcome parameters, such as a reduction of muscle tone [63,85], an increased range of joint motion [32,63,85,87], an improved gait pattern [32,87], an increased muscle length [88] and improved function through the Gross Motor Function Measure [39]. Different types of assessment tools were used in the performed studies until now, which may explain the variety of treatment outcome parameters.…”

“…Most of them, however, focus on single, onelevel BTX-A treatment in CP [30][31][32][33][34][35]. A few studies, though, highlight the need and overall better response of multi-level injections [12,[36][37][38][39]. Bakheit et al [36] concluded, from a study of 1,594 treatments in children with muscle spasticity, that multi-level treatments with BTX-A resulted in a better overall response than singlelevel treatments.…”

The effect of different physiotherapy interventions in post-BTX-A treatment of children with cerebral palsy

“…Only few studies investigated this combined effect of a BTX-A treatment program with an intensive physiotherapy program. 10,23,24 Outcome measures seem to be very variable and no consensus is found on which specific exercises and techniques are indicated to optimize the effect of tonereduction. 25 The purpose of this study was to distinguish the effects of different physiotherapeutic interventions on gait and clinical parameters of 76 children with CP in a post BTX-A regime, evaluated by means of the Goal Attainment Scale (GAS).…”

Estimation of botulinum toxin type A efficacy on spasticity and functional outcome in children with spastic cerebral palsy

“…It was noticed that younger children with I and II functional levels on GMFCS scale had higher consistent improvement, while older CP children with III and IV functional levels on the GMFCS scale had non significant improvements. One possible explanations could be the fact that children with moderate to severe physical limitations have lower potential for motoric functions improvement, with particular group at IV and V levels on the GMFCS scale, where limitation factor is contractures 24,25 . Our results were consistent with previous reports, pointing to the increase in motoric functions since the followed-up sample consisted of CP patients with functional levels from I to III.…”