The effect of serial casting on gait in children with cerebral palsy: preliminary results from a crossover trial

McNee, Anne; Will, Elspeth; Lin, Jean-Pierre; Eve, Linda; Gough, Martin; Morrissey, Matthew C.; Shortland, Adam P

doi:10.1016/j.gaitpost.2006.08.002

Cited by 48 publications

(39 citation statements)

References 42 publications

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“…Management of gait dysfunction in patients with cerebral palsy may include nonoperative measures, such as physiotherapy [45], orthotics [5], casting [19], and injections of botulinum toxin type A [17]. Despite appropriate nonoperative management, however, the majority of patients with spastic diplegia will have fixed contractures and bony deformities develop which require surgical correction to maintain gait or even sitting functions.…”

mentioning

confidence: 99%

Are Results After Single-event Multilevel Surgery in Cerebral Palsy Durable?

Rutz

Baker

Tirosh

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Gait and function may deteriorate with time in patients with spastic diplegia. Single-event multilevel surgery often is performed to either improve gait or prevent deterioration. However it is unclear whether the presumed gait improvements are durable. Questions/purposes We therefore determined whether (1) single-event multilevel surgery improves gait in patients with spastic diplegia and (2) whether the improved function is durable.

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mentioning

confidence: 99%

Are Results After Single-event Multilevel Surgery in Cerebral Palsy Durable?

Rutz

Baker

Tirosh

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…As for the longevity of the effects of casting application for the equinus of children with CP, some studies revealed long-lasting changes throughout the 12-month follow-up period,14,16 while others showed much shorter-lasting effects 2,3. A single fixed cast application in conjunction with a BTX-A injection, in comparison with BTX-A alone, resulted in more enduring effects in the reports by Bottos, et al17 and Ackman, et al16 In contrast, the addition of BTX to serial casting revealed shorter-term effects, compared to serial casting alone, in cases of fixed contracture in the report by Kay, et al14 With our short-term follow-up study, we could not determine the time when the effects of the interventions started to deteriorate because the follow-up periods in our cases varied.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, such an intervention may help to prevent contracture or to postpone surgical intervention. Currently, a number of conservative interventions for managing equinus in children with CP are available, such as bracing, stretching exercises, electrical stimulation, and casts/serial casting 1-3. Botulinum toxin type A (BTX-A) injection into triceps surae muscles has been considered an effective therapeutic approach.…”

Section: Introductionmentioning

confidence: 99%

Short-Term Effects of Combined Serial Casting and Botulinum Toxin Injection for Spastic Equinus in Ambulatory Children with Cerebral Palsy

et al. 2010

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PurposeThe purpose of this paper is to test the hypothesis that combination therapy of serial cast and botulinum toxin type A (BTX-A) injection can further enhance the effects of a BTX-A injection in ambulant children with cerebral palsy (CP) who have an equinus foot.Materials and MethodsChildren in group A (30 legs of 21 children) received a serial casting application after an injection of BTX-A, and children in group B (25 legs of 17 children) received only a BTX-A injection. Assessments were performed before the intervention and 1 month after the intervention.ResultsAfter the intervention, there were significant improvements in tone, dynamic spasticity, and passive range of motion (ROM) in both groups. However, the changes were greater in group A than in group B. Dimension D (standing) in Gross Motor Function Measure (GMFM)-66 was significantly improved in group A but not in group B. On the other hand, there were no significant changes in di-mension E (walking, running, jumping) in GMFM-66 in either group.ConclusionThe results of our study suggest that a serial casting application after BTX-A injection can enhance the benefits of BTX-A injection in children with cerebral palsy.

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“…Cross-over designs are also more efficient than standard RCTs or repeated measure designs, requiring fewer participants (Louis et al 1984). While there may be concern that the extended length of involvement in the trial to complete both phases may be an obstacle for enrolment or adherence, cross-over designs have been successfully employed in CP and Lokomat research (McNee et al 2007; Mayr et al 2007). Furthermore, the opportunity to receive both intervention arms and be assured access to the Lokomat is thought to outweigh any perceived burden of the time commitment (Law et al 1997).…”

Section: Designmentioning

confidence: 99%

Comparison of a robotic-assisted gait training program with a program of functional gait training for children with cerebral palsy: design and methods of a two group randomized controlled cross-over trial

2016

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BackgroundEnhancement of functional ambulation is a key goal of rehabilitation for children with cerebral palsy (CP) who experience gross motor impairment. Physiotherapy (PT) approaches often involve overground and treadmill-based gait training to promote motor learning, typically as free walking or with body-weight support. Robotic-assisted gait training (RAGT), using a device such as the Lokomat®Pro, may permit longer training duration, faster and more variable gait speeds, and support walking pattern guidance more than overground/treadmill training to further capitalize on motor learning principles. Single group pre-/post-test studies have demonstrated an association between RAGT and moderate to large improvements in gross motor skills, gait velocity and endurance. A single published randomized controlled trial (RCT) comparing RAGT to a PT-only intervention showed no difference in gait kinematics. However, gross motor function and walking endurance were not evaluated and conclusions were limited by a large PT group drop-out rate.Methods/designIn this two-group cross-over RCT, children are randomly allocated to the RAGT or PT arm (each with twice weekly sessions for eight weeks), with cross-over to the other intervention arm following a six-week break. Both interventions are grounded in motor learning principles with incorporation of individualized mobility-based goals. Sessions are fully operationalized through manualized, menu-based protocols and post-session documentation to enhance internal and external validity. Assessments occur pre/post each intervention arm (four time points total) by an independent assessor. The co-primary outcomes are gross motor functional ability (Gross Motor Function Measure (GMFM-66) and 6-minute walk test), with secondary outcome measures assessing: (a) individualized goals; (b) gait variables and daily walking amounts; and (c) functional abilities, participation and quality of life. Investigators and statisticians are blinded to study group allocation in the analyses, and assessors are blinded to treatment group. The primary analysis will be the pre- to post-test differences (change scores) of the GMFM-66 and 6MWT between RAGT and PT groups.DiscussionThis study is the first RCT comparing RAGT to an active gait-related PT intervention in paediatric CP that addresses gait-related gross motor, participation and individualized outcomes, and as such, is expected to provide comprehensive information as to the potential role of RAGT in clinical practice. Trial registration ClinicalTrials.gov NCT02196298Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-3535-0) contains supplementary material, which is available to authorized users.

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The effect of serial casting on gait in children with cerebral palsy: preliminary results from a crossover trial

Cited by 48 publications

References 42 publications

Are Results After Single-event Multilevel Surgery in Cerebral Palsy Durable?

Are Results After Single-event Multilevel Surgery in Cerebral Palsy Durable?

Short-Term Effects of Combined Serial Casting and Botulinum Toxin Injection for Spastic Equinus in Ambulatory Children with Cerebral Palsy

Comparison of a robotic-assisted gait training program with a program of functional gait training for children with cerebral palsy: design and methods of a two group randomized controlled cross-over trial

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