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European Journal of Physical and Rehabilitation Medicine 2018 October;54(5):757-65

DOI: 10.23736/S1973-9087.17.04940-1

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Effect of physiotherapeutic intervention on the gait after the application of botulinum toxin in children with cerebral palsy: systematic review

Paulo R. FONSECA Jr 1 , Renata CALHES FRANCO de MOURA 2, Manuela GALLI 3, Claudia SANTOS OLIVEIRA 4

1 Nove de Julho University, São Paulo, Brazil; 2 Physical Therapy Department, Universidade de Mogi das Cruzes, Mogi das Cruzes, Brazil; 3 Department of Electronics, Information Technology, and Bioengineering, Polytechnic Institute of Milan, Milan, Italy; 4 University Center of Anápolis - UniEvangélica, Anápolis, Brazil



INTRODUCTION: Cerebral palsy is a group of movement and posture development disorders. 90% of this population has gait impairment, often due to the presence of spasticity. A number of studies emphasize the importance of combined physical therapy with botulinum toxin A treatment. However, no consensus can be reached concerning the content of the physiotherapy program after treatment with botulinum toxin A. The purpose of the present study was to investigate, through a systematic review of the literature, the effects of physiotherapeutic intervention on gait after botulinum toxin application in children with cerebral palsy.
EVIDENCE ACQUISITION: PubMed, Scielo, Cochrane Library, OTseeker, and PEDro databases were searched for randomized trial published between January 2000 and January 2017.
EVIDENCE SYNTHESIS: Sixty-eight articles were identified, four of which met the eligibility criteria and were selected for the present systematic review. A table was created showing the main characteristics of the studies (groups, inclusion criteria, dosage, injection site, physiotherapeutic intervention, evaluation and outcomes).
CONCLUSIONS: This study offers a view on the increase in the therapeutic effectiveness of botulinum toxin A on the lower limbs when used in conjunction with a physiotherapeutic intervention, with improvements in mobility, gait pattern, range of motion and spasticity, which are maintained after the end of the physical therapy protocol. The use of botulinum toxin A on the lower limbs when used in conjunction with a physiotherapeutic intervention, can improve muscle tone, allowing a combined treatment and intended to provide improvement of motor ability and functional skills, and potentially, delay the need for surgery.


KEY WORDS: Botulinum toxin type A - Rehabilitation - Cerebral palsy - Child - Gait - Physical therapy modalities

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