Article

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
http://www.physiatry.org/JournalCME 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.

Langue : ANGLAIS