Effectiveness of Serial Casting Alone and in Combination with Botulinum Neurotoxin in Pediatric Spastic Cerebral Palsy Patients

Abstract

Purpose This study evaluated the changes in gait of pediatric cerebral palsy patients after serial casting alone and serial casting in conjunction with botulinum neurotoxin treatments. Methods Retrospective data of 31 children were investigated. Sixteen children were treated with serial casting combined with BoNT injection and 15 children were treated only with serial casting treatment. GAITRite was used to collect velocity, cadence, swing %, stance %, step length, stride length, and step time parameters to compare the outcomes of the treatments. Results Combined treatment group unaffected side swing % showed a statistically significant difference at completion (M = 35.16 ±1.21; M = 32.46 ± 1.38; t (15) = 2.12, p = 0.049). Unaffected side stance % at pre-intervention was statistically different for serial casting only and the combined treatment groups (M = 61.69± 0.73; M = 64.88±1.20; t (14) = -2.273, p = 0.039). Pre- and post-intervention hemiplegic side swing % comparison was statistically significant for the serial casting only group (M = 40.87± 0.57; M = 42.39±0.79, t (14) = -0.151, p = 0.032). The baseline velocity of the combined treatment group was slower than the serial casting-only group (88±11.2 vs. 107±14.4 (cm/s), p=0.007). Conclusions This investigation suggests that for patients, who have poor ambulation quality, abnormal spatiotemporal gait parameters, and significant spasticity at pre-intervention, BoNT in conjunction with serial casting is more effective for improving ambulation quality. Serial casting can be used in conjunction with botulinum neurotoxin, which is efficient in muscle morphology and function regulation by reducing spasticity.