Effect of combined rehabilitation program with botulinum toxin type A injections on gross motor function scores in children with spastic cerebral palsy

Abstract

[Purpose] To examine whether combining botulinum toxin type A with physiotherapy is better than botulinum toxin type A alone in reducing muscle tone and improving gross motor function in spastic diplegia. [Subjects and Methods] Forty-six ambulatory children with spastic diplegia (age: 25-154 months) were recruited. Patients were assigned to Groups 1 (n=18) and 2 (n=28). After baseline assessment, all children received botulinum toxin type A injections (6 units/kg) into the lower limb muscles. A second botulinum toxin type A injection was given 6 months later. The ankles were placed in plaster casts for 2 weeks after the first injection and an orthosis was prescribed after cast removal. Group 2 received 2 weeks of intensive physiotherapy. The gross motor function scores for the 2 groups were recorded at baseline, 4, 6, and 52 weeks. [Results] The improvement in gross motor function scores was significant for Group 2 and non-significant for Group 1. After 4, 6, and 52 weeks, Groups 1 and 2 showed 2.6% and 6.3% improvement, 4.8% and 12% improvement, and 5.5% and 19.4% improvement, respectively. [Conclusion] The addition of a 2-week physiotherapy programme after the initial botulinum toxin type A injections produced significantly greater improvements in gross motor function scores.