Assessment protocol for serial casting after botulinum toxin A injections to treat equinus gait

PURPOSE: The purpose of this study was to investigate feasibility of an assessment protocol for a trial of post-Botox casting to treat equinus gait in cerebral palsy. METHODS: Ten children (ages, 26-75 months) were recruited. Nine were assessed 1 week before botulinum toxin-A injections and reassessed 1 week after removal of the final cast. The assessment protocol included Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), Gross Motor Function Measure-66 (GMFM-66), Pediatric Evaluation of Disability Inventory (PEDI), and GAITRite. Feasibility was based on acceptability of the protocol, inter-rater reliability, and responsiveness of outcome measures. RESULTS: The assessment protocol was acceptable and practical. Inter-rater reliability for MAS, MTS, and GMFM ranged from moderate to excellent. Improvements were found in MTS and MAS scores for dorsiflexion and hamstring (p < 0.01), GMFM-66 (p ≤ 0.01), and Pediatric Evaluation of Disability Inventory mobility (p ≤ 0.01), self-care (p ≤ 0.01), and social function (p ≤ 0.00). GAITRite revealed reductions in speed (p ≤ 0.00) and cadence (p ≤ 0.01). CONCLUSIONS: Feasibility was confirmed. Recommendations include raising minimum age and delaying gait analysis.