Botulinum toxin A versus fixed cast stretching for dynamic calf tightness in cerebral palsy

Objective: To compare botulinum toxin A injections with fixed plaster cast stretching in the management of cerebral palsied children with dynamic (i.e . non-fixed) calf tightness. Methods: The settings were the Women's and Children's Hospital (WCH) and th e Crippled Children's Association of South Australia (CCA), Adelaide, South Australia. Twenty children were selected by two paediatric rehabilitation specialists. A prospective, randomized, single-blind controlled study, was carried out, with 10 children in each arm. The clinicians were blinded as t o the allocated interventions. The outcome measures for 6 months post inter vention were clinical assessment, modified Ashworth Scale, Gross Motor Func tion Measure, 2 D-video ratings using a modified Physical Rating Scale and a global scoring scale and a parent satisfaction questionnaire. Results and Conclusion: Botulinum toxin A injections were of similar effica cy to serial fixed plaster casting in improving dynamic calf tightness in a mbulant or partially ambulant children with cerebral palsy. The ease of out patient administration, reduction of muscle tone and safety with botulinum toxin A was confirmed. Parents consistently favoured botulinum toxin A and highlighted the inconvenience of serial casting.