This review examines the effectiveness of integrating botulinum toxin type A (BONT-A) with various rehabilitative strategies in treating spastic diplegia in children. The studies analyzed consistently demonstrate significant reductions in spasticity and improvements in gait when BONT-A is combined with interventions such as intensive physical therapy, serial casting, electrical stimulation, physiotherapy, occupational therapy, and robotic-assisted gait training. The findings underscore the importance of personalized rehabilitation plans tailored to each child's needs. Early intervention is particularly effective in preventing spasticity and related complications, leading to better long-term outcomes. Despite the robust results, limitations such as heterogeneity in rehabilitative approaches, small sample sizes, and varying follow-up durations necessitate further research. Future studies should focus on larger, multicenter randomized controlled trials with standardized outcome measures and more extended follow-up periods to validate these findings and assess the long-term sustainability of treatment benefits. The review highlights the necessity of interdisciplinary collaboration among healthcare professionals to ensure comprehensive care, which is crucial for optimizing therapeutic outcomes. The consistent improvements in both spasticity reduction and gait functionality emphasize the critical role of integrated treatment approaches in enhancing the quality of life for pediatric patients with cerebral palsy. The evidence supports the implementation of comprehensive, personalized rehabilitation strategies in clinical practice, promoting early and proactive management to achieve the best possible outcomes for children with spastic diplegia. This review provides a foundation for developing best practices and guiding future research in pediatric neurorehabilitation.
