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Randomized Controlled Trial on Effectiveness of Intermittent Serial Casting on Spastic Equinus Foot in Children with Cerebral Palsy After Botulinum Toxin-A Treatment

Dursun, Nigar MD; Gokbel, Tugba MD; Akarsu, Melike BA; Dursun, Erbil MD

American Journal of Physical Medicine & Rehabilitation: April 2017 - Volume 96 - Issue 4 - p 221–225
doi: 10.1097/PHM.0000000000000627
Original Research Articles CME Article . 2017 Series . Number 5

Objective Physical therapy (PT) and botulinum toxin-A (BTX-A) injections are widely used in the treatment of spastic equinus foot due to cerebral palsy. The aim of this study was to show effects of intermittent serial casting (SC) in addition to standard treatment on spasticity, passive range of motion (PROM), and gait.

Design Fifty-one ambulatory patients, treated by BTX-A to plantar flexor muscles, were randomly assigned to casting or control groups in a 2:1 ratio. Both groups received PT for 3 weeks. Casting group additionally received intermittent SC during 3 consecutive weekends. Assessments included Modified Ashworth Scale (MAS), Tardieu Scale, Observational Gait Scale (OGS), and Physician Global Assessment at baseline and posttreatment weeks 4 and 12.

Results Significant improvements in PROM, MAS, Tardieu Scale, and OGS were recorded in both groups (P < 0.001 for all). Average changes in MAS, PROM, angle of catch, spasticity angle, and OGS of the casting group were significantly higher than those of the controls at week 4 (P = 0.006, P = 0.002, P < 0.001, P = 0.005, P = 0.011), and 12 (P = 0.013, P < 0.001, P < 0.001, P = 0.011, P < 0.001). Follow-up Physician Global Assessment also favored casting group (P < 0.001 for both).

Conclusions Combining intermittent SC with BTX-A injections and PT might provide additional benefits for spastic equinus foot.

To Claim CME Credits Complete the self-assessment activity and evaluation online at

CME Objectives Upon completion of this article, the reader should be able to: (1) identify treatment options for spastic equinus goot in children with cerebral palsy; (2) explain different approaches of serial casting with an additional model of intermittent casting; and (3) describe the potential benefits of combined treatment modalities, including intermittent serial casting, for spastic equinus foot in children with cerebral palsy.

Level Advanced

Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

From the Department of Physical Medicine and Rehabilitation, Kocaeli University, Kocaeli, Turkey.

All correspondence and requests for reprints should be addressed to: Nigar Dursun, MD, Kocaeli Universitesi Tip Fakultesi, FTR AD, Umuttepe Kampusu, Kocaeli, Turkey.

Dr Dursun reports research support from Ipsen, Allergan, and Merz; fees for consulting/advisory boards from Ipsen and Merck Sharpe and Dohme (MSD); and speaker fees from MSD, Abdi Ibrahim, and Pfizer. Dr Dursun E also reports speaker fees from MSD and Pfizer; Dr Gokbel and Akarsu do not report any financial disclosure.

The study was performed in Kocaeli University Department of Physical Medicine and Rehabilitation/Turkey.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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