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° and 5°, P < 0.01, respectively); hip rotation during terminal swing (4°, P = 0.02); gait score (1.7, P < 0.01); decreased spasticity in hamstrings (11°, P < 0.01), gastrocnemius (6°, P = 0.01), and soleus (5°, P = 0.02); and increased muscle length in hamstrings (9°, P < 0.01) and gastrocnemius (5°, 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.