Casting Protocols Following BoNT-A Injections to Treat Spastic Hypertonia of the Triceps Surae in Children with Cerebral Palsy and Equinus Gait: A Randomized Controlled Trial

ABSTRACT

Aim: To study the effects of single versus serial casting post-Botulinum toxin A (BoNT-A) injections on hypoextensibility of triceps surae in children, 2–7 years old, with cerebral palsy and equinus gait. Methods: A randomized, stratified, parallel, two-group trial was conducted at a pediatric health center with assessments at baseline, precast, postcast and, 1-, 2-, and 6-month follow-ups. One week following BoNT-A injections into triceps surae muscle, a single below-knee cast (n = 10) or 3 serial casts (n = 10) were applied for 3 weeks. Primary outcome measure was the Modified Tardieu Scale (MTS), secondary outcome measures were Modified Ashworth Scale (MAS), GAITRite™, Gross Motor Function Measure-66 (GMFM-66), and Pediatric Evaluation of Disability Inventory (PEDI). Results: Significant effects of time, but not group-by-time, were found for MTS R1 (P < 0.001), MTS R2 (P < 0.001), MAS (P = 0.001), GMFM-66 (P = 0.002), and PEDI (P < 0.001–0.009). One participant who received a single cast did not complete the 6-month assessment. Conclusions: Magnitudes of improvements were similar using single or serial casting. If these findings are corroborated in a larger scale study, the recommendation of a single cast may be appropriate due to its greater convenience for families and clinicians.

KEYWORDS:

• cerebral palsy
• child
• casts
• Botulinum toxin type-A
• spastic hypertonia
• equinus gait

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Acknowledgments

The authors thank the participating children and their families and Connie Bailey BSc, PT, Paula Dunn RN, Lyn Ivany R.T. Orthoped (C), Sharon Joyce R.T. Orthoped (C), and Matt Tancock, Orthopaedic Technologist, for their assistance throughout.

Additional information

Funding

This study was supported by grants from the Nova Scotia Health Research Foundation, Physiotherapy Foundation of Canada and IWK Health Centre, Halifax Nova Scotia, Canada.