EFFECTS OF SERIAL CASTING WITH AND WITHOUT BOTULINUM TOXIN INJECTIONS AS INTERVENTIONS FOR SPASTIC ANKLE EQUINUS

Abstract

Serial casting (SC) and Botulinum toxin-A (Btx-A) have been used to treat ankle equinus contractures in cerebral palsy. Previous studies that examined the effects of combining Btx-A injections with SC and either one of the treatments alone in terms of passive ankle range of motion (PROM) have shown mixed results [two-four]. Therefore, the goal of this study is to examine PROM and gait characteristics in children with CP who have undergone SC, either with or without Btx-A injections to the plantarflexors.

Patients who underwent SC +/− Btx-A injections were evaluated for improvement in PROM at the end of treatment. The participants’ age at beginning of SC treatment, Gross Motor Function Classification System (GMFCS) level, treatment duration, PROM, and gait characteristics observed by the treating physiotherapist were obtained from the charts. Only one side per treatment is included in this study (treated side for unilateral treatments, randomly chosen side for bilateral treatments). Table One shows the characteristics of the two groups.

Independent samples t-tests showed that the two groups are similar in terms of age, treatment duration and pre PROM. A repeated measures ANCOVA, using the pre- and post- treatment range of motion as the within subject variables, treatment type as the between subject variable, and GMFCS and age as the covariates showed that the PROM changed significantly regardless of treatment type (p< 0.001). However, the treatment type does not influence the outcome (p=0.411). The changes in range of motion obtained from the two types of treatments were not significantly different using the independent t-test (p=0.957).

Based on these results, it appears that both types of interventions resulted in significant changes in ankle passive range of motion, which is in agreement with Kay et al [4]. Similar ranges of motion at the end of the treatment were obtained from both treatments, and the treatments have similar success rates. Future work is needed to further explore the outcomes associated with serial casting only and Btx-A and serial casting treatments