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

Pediatr Phys Ther. 2008 Fall;20(3):233-41. doi: 10.1097/PEP.0b013e3181825c1b.


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.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Botulinum Toxins / administration & dosage*
  • Botulinum Toxins / adverse effects
  • Casts, Surgical*
  • Cerebral Palsy / complications
  • Child
  • Child, Preschool
  • Cohort Studies
  • Disability Evaluation
  • Equinus Deformity / complications
  • Equinus Deformity / drug therapy
  • Equinus Deformity / therapy*
  • Feasibility Studies
  • Female
  • Gait / drug effects*
  • Gait / physiology
  • Gait Disorders, Neurologic / drug therapy*
  • Gait Disorders, Neurologic / etiology
  • Gait Disorders, Neurologic / physiopathology
  • Humans
  • Injections, Intramuscular
  • Male
  • Muscle Hypertonia / chemically induced
  • Pilot Projects
  • Reproducibility of Results
  • Time Factors


  • Botulinum Toxins