Effect of multilevel botulinum toxin A and comprehensive rehabilitation on gait in cerebral palsy

To evaluate the effect of multilevel botulinum toxin A and comprehensive rehabilitation on gait pattern, muscle length, and spasticity, a multicenter randomized trial was performed in 46 children with spastic cerebral palsy who walk with flexed knees. Their mean age was 8.0 years (range 4 to 11 years). They were randomly allocated to the intervention group (multilevel botulinum toxin A and comprehensive rehabilitation) or the control group (usual care). After 6 weeks, a significant treatment effect in the intervention group was observed on: improved knee extension during midstance and terminal swing (7 degrees and 5 degrees, P < 0.01, respectively); hip rotation during terminal swing (4 degrees, P = 0.02); gait score (1.7, P < 0.01); decreased spasticity in hamstrings (11 degrees, P < 0.01), gastrocnemius (6 degrees, P = 0.01), and soleus (5 degrees, P = 0.02); and increased muscle length in hamstrings (9 degrees, P < 0.01) and gastrocnemius (5 degrees, P < 0.01). The improved muscle length was maintained up to 24 weeks. This study demonstrated that multilevel botulinum toxin A and comprehensive rehabilitation improves knee extension during gait, increases muscle length, and decreases spasticity in injected muscles after 6 weeks in children who walk with flexed knees. Although the effect on muscle length was maintained after 24 weeks, the effect on gait and spasticity had disappeared. (c) 2007 by Elsevier Inc. All rights reserved.