Affiliations: [a] Gait Analysis Laboratory, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark | [b] Department of Physical Therapy, Copenhagen University Hospital, Hvidovre, Denmark | [c] Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark | [d] Department of Exercise and Sport Sciences, University of Copenhagen, Copenhagen, Denmark | [e] Department of Pediatrics, Copenhagen University Hospital, Hvidovre, Denmark
Correspondence:
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Corresponding author: Thomas Bandholm, Clinical Research Center, Copenhagen University Hospital, Hvidovre, Kettegaard Allé 30, DK-2650, Hvidovre, Denmark. Tel.: +45 3862 6344; Fax: +45 3862 3797; E-mail: [email protected]
Abstract: Objective:To compare the effects of physical rehabilitation with (PRT) and without (CON) progressive resistance training following treatment of spastic plantarflexors with botulinum toxin type A (BoNT) in children with cerebral palsy (CP). Methods:Fourteen children with CP performed supervised PRT (n = 7) or CON (n = 7) two times per week for 12 weeks, following the BoNT-treatment. Outcome measurements were performed at baseline (pre BoNT), and 4 and 12 weeks post BoNT. They consisted of: ankle muscle function (maximal torque and submaximal torque steadiness of isometric ankle dorsi- and plantarflexion and associated ankle muscle [EMG] activity), gait function (3-dimensional gait analysis), balance function (sway analysis), gross motor function (GMFM-66), and spasticity (modified Ashworth). Results:Submaximal torque control (torque steadiness) of isometric dorsiflexion improved similarly in the two groups, and the improvement was related to the reduction in antagonist (soleus) co-activity (P < 0.05). Maximal plantarflexion torque increased after PRT, whereas a reduction was seen after CON (P < 0.05). No changes in function were observed. Conclusions:Both types of physical rehabilitation in combination with BoNT-treatment improved antagonist (ankle dorsiflexion) torque-control to the same extent – which was related to the reduction in antagonist co-activity – but only rehabilitation with PRT increased maximal plantarflexion torque.
