BACKGROUND-Spasticity is a prevalent disabling clinical symptom for children with cerebral palsy. Treatment of spasticity with botulinum toxin in children with cerebral palsy was first reported in 1993. Botulinum toxin provides a focal, controlled muscle weakness with reduction in spasticity. Interpretation of the literature is difficult due to the paucity of reliable measures of spasticity and challenges with measuring meaningful functional changes in children with disabilities.

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We performed a prospective randomized trial to compare the effects of selective dorsal rhizotomy with intensive physical therapy to intensive physical therapy alone in a group of children with mild spastic diplegic cerebral palsy. Instrumented gait analysis was carried out upon enrollment into the study and after 1 year. Changes in ambulatory status, time/distance parameters, and gait kinematics were observed for both groups. Considerable variability was present in both groups. Changes in ankle dorsiflexion, foot progression angle, and hip and knee extension in stance were significantly better in the selective dorsal rhizotomy group compared to the physical therapy group at 1 year (p < 0.05). These differences were not associated with significant improvements in functional gait as determined by changes in time/distance parameters or ambulatory status.

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