Effect of Botulinum Toxin with Rehabilitation Therapy on Standing in Children with Spastic Diplegic Cerebral Palsy

Background: The ability to stand is a major concern for parents of children with cerebral palsy (C.P.). Acquisition or improving standing ability is often considered to be the primary focus of most therapeutic interventions. Objective: To assess the effect of botulinum toxin typeA (BTX-A) injection when combined with rehabilitation therapy on improving the standing ability in children with spastic diplegic C.P. Methods: Thirty children with spastic diplegic C.P., aged 3 to 5 years, participated in this study. They had moderate spasticity, no fixed contracture in the lower limbs and ability to stand holding on. They were randomly assigned into two equal groups; study and control groups. Children in study group received intramuscular injections of BTX-A into lower limbs followed by a rehabilitation program for successive six months. While children in control group received the same rehabilitation program only. The program consisted of passive stretching for spastic muscles, strengthening for antispastic muscles, training of standing and ankle foot orthosis. Spasticity, range of motion (ROM) and standing ability were evaluated before and after three and six months of treatment by using Modified Ashworth Scale, electronic goniometer and Gross Motor Function Measure. Results: Both groups showed a statistically significant reduction in spasticity, increase in ROM and improvement of standing ability at the end of the study. Moreover, significant differences were observed between both groups in all measuring variables after 3 and after 6 months of treatment but in favor of the study group. Conclusion: BTX-A combined with rehabilitation therapy resulted in long lasting decrease of spasticity, increase of ROM and improvement of standing ability in children with spastic diplegic C.P.