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Efficacy of botulinum toxin A, serial casting, and combined treatment for spastic equinus: a retrospective analysis

Published online by Cambridge University Press:  10 November 2004

Allan M Glanzman ,
Heakyung Kim ,
Kartik Swaminathan  and
Teresa Beck
Allan M Glanzman
Affiliation:
Division of Child Development, Physical Medicine and Rehabilitation, and Metabolism, Children's Seashore House of The Children's Hospital of Philadelphia, USA.
Heakyung Kim
Affiliation:
Division of Child Development, Physical Medicine and Rehabilitation, and Metabolism, Children's Seashore House of The Children's Hospital of Philadelphia, USA.
Kartik Swaminathan
Affiliation:
Department of Physical Medicine and Rehabilitation, Temple University, USA.
Teresa Beck
Affiliation:
Department of Nursing, Children's Seashore House of The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Abstract

Botulinum toxin type A (BTX-A), serial casting, and combined treatment for spastic equinus were compared by chart review. Fifty-five patients with diplegia (n=21), hemiplegia (n=17), quadriplegia (n=6), and other diagnoses (n=11) were reviewed. Thirty-one patients had Gross Motor Function Classification System (GMFCS) scores of I or II, 10 had a GMFCS score of III, and eight had GMFCS scores of IV or V (for six there were no available data). Mean age was 7 years 1 month (SD 4 y 8mo). The combined group showed a significantly greater increase in passive range of motion (ROM) of the ankle joint in comparison with BTX-A alone (p=0.0002), with a mean of 17° (SD 11.2) versus 5° (SD 6.7), and casting alone showed a significantly greater increase in comparison with BTX-A alone (p=0.0001), with a mean of 15° (SD 4.5) versus 5° (SD 6.7). With cast number controlled, change in ROM after casting with and without BTX-A was not significantly different (p=0.37). There was no significant difference between casting with or without BTX-A, and both improved ROM to a greater degree than BTX-A alone. Casting demonstrated a significantly more robust impact on range of motion than BTX-A alone.

Type
Original Articles
Information
Developmental Medicine and Child Neurology , Volume 46 , Issue 12 , December 2004 , pp. 807 - 811
Copyright
© 2004 Mac Keith Press

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