2004
DOI: 10.2106/00004623-200411000-00003
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Botulinum Toxin as an Adjunct to Serial Casting Treatment in Children with Cerebral Palsy

Abstract: Background: Although botulinum toxin A is frequently used to augment serial casting in the treatment of soft-tissue contractures in children with cerebral palsy, its effectiveness for this purpose has not been evaluated. The purpose of the present study was to determine whether botulinum toxin A injection increases the efficacy of serial casting. Methods: A prospective, randomized trial was undertaken to compare serial casting only with serial casting combined with botulinum toxin A (Botox) injection for the t… Show more

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Cited by 117 publications
(145 citation statements)
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“…In contrast with these authors' findings, in our study we observed that patients with a high degree of motor limitation were precisely those who had the worst response to BoNT/A treatment. Kay et al 26 followed up 23 children over the age of four years with more severe CP (including patients with quadriplegia) who had dystonic movements and fixed contractures in the ankle. The authors did not observe any differences between lower-limb spasticity in the group that received BoNT/A and that in the group that had been treated with physical therapy alone.…”
Section: Discussionmentioning
confidence: 99%
“…In contrast with these authors' findings, in our study we observed that patients with a high degree of motor limitation were precisely those who had the worst response to BoNT/A treatment. Kay et al 26 followed up 23 children over the age of four years with more severe CP (including patients with quadriplegia) who had dystonic movements and fixed contractures in the ankle. The authors did not observe any differences between lower-limb spasticity in the group that received BoNT/A and that in the group that had been treated with physical therapy alone.…”
Section: Discussionmentioning
confidence: 99%
“…One recent publication has shown that the equinus associated with considerable soft-tissue contractures is worsened when BTX-A is added to a serial casting regime. 46 If BTX-A injection alone is used in patients with fixed contractures, severe spasticity or mixed hypertonia, who cannot tolerate serial casting well, it is unlikely that significant improvement in movement will occur.…”
Section: Cerebral Palsymentioning
confidence: 99%
“…11,18,29 However, questionnaires as measurements of outcome provide information on the perception of treatment by children and parents but lack the objectivity and reproducibility of more formal motor function scales. The Gross Motor Function Measure, 14,21,30 Global Attainment Scale, 23,34 and Global Scoring Scale 11 all have been used to demonstrate significant improvements in function after injection of BTA in the ankle flexors, adductors, and hamstrings, but each measurement device has limitations. Although the Gross Motor Function Measure is a widely used tool for assessment of motor performance and has shown good reliability and validity in children with CP, 30 it is of limited benefit in severely affected children.…”
Section: Motor and Function Scales And Disabilitymentioning
confidence: 99%
“…4,7,9,11,14 In most studies, injections were given in the ankle flexors (gastrocnemius and soleus muscles), although authors of one study investigated the effect of BTA injections in multiple sites. 9 In two studies, outcomes were compared for placement of serial casts and BTA injections as separate treatments.…”
Section: Serial Casts and Btamentioning
confidence: 99%
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