Turkish Journal of Physical Medicine and Rehabilitation 2008 , Vol 54 , Num 2

Comparison of the Effectiveness of Physiotherapy and Ankle Foot Orthosis After Botulinum Toxin Injection in Diplegic Cerebral Palsy Patients

Ümit Dinçer 1 ,Engin Çakar 2 ,Mehmet Zeki Kıralp 3 ,Hasan Dursun 4
1 Gata Haydarpaşa Eğitim Hastanesi, Fizik Tedavi ve Rehabilitasyon Kliniği, İstanbul, Türkiye
2 GATA Haydarpaşa Training Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
3 Gülhane Askeri Tıp Akademisi Haydarpaşa Eğitim Hastanesi Fiziksel Tıp ve Rehabilitasyon Servisi, İstanbul, Türkiye
4 Gülhane Askeri Tıp Akademisi, Haydarpaşa Eğitim Hastanesi Fizik Tedavi ve Rehabilitasyon Kliniği, İstanbul

Objective: The purpose of this study was to compare the effects of BTX-A plus physiotherapy and BTX-A plus ankle foot orthosis on spasticity, walking ability and range of motion (ROM) in spastic diplegic cerebral palsy (CP). 

Materials and Methods: Children were randomly assigned to one of two treatment groups: BTX-A+physiotherapy (n=10) (PTG) and, BTX-A+orthosis (n=10) (OG). After the BTX-A injections, an individualized physiotherapy program was applied in PTG and an ankle foot orthosis was applied in OG. Assessments were performed at baseline, 2 and 12 weeks. The passive ankle ROM was assessed with knee flexion and knee extension, spasticity was assessed with the Ashworth scale and walking ability was evaluated with the Physician Rating Scale (PRS).

Results: Nineteen patients completed the study (PTG=10, OG=9; in PTG 6 male and 4 female; in OG 5 male and 4 female). Mean age was 5.70±2.49 and 6.88±1.83 years; respectively. Ankle ROMs were 36.50±4.88 degrees in PTG and 41.77±8.08 degrees in OG at baseline measurement. After 12 weeks, ankle ROMs were 50.30±7.02 and 45.88±9.95 respectively. In-group comparison of these results showed statistically significant differences (p<0.05) but in intergroup comparisons of results there were no statistically significant differences (p>0.05). The composite PRS scores were 8.40±1.50 and 8.55±0.72 at baseline. PRS scores were measured as 11.00±2.00 and 10.88±1.36 respectively. In both groups, statistically significant improvements were obtained in spasticity measurements (p=0.005) but the intergroup comparison of these results were not statistically 
significant (p=0.011). 

Conclusion: The BTX-A injections in gastrocnemius muscles combined with physiotherapy and orthosis, could improve spasticity and walking ability. Physiotherapy has a superior effect on improvement of ankle ROM. However, there was no superiority between BTX-A+ physiotherapy and BTX-A+ orthosis groups in overall clinical evaluations. 

Keywords : Cerebral Palsy, botulinum toxin, physiotherapy, orthosisi