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

Eur J Phys Rehabil Med. 2018 Oct;54(5):757-765. doi: 10.23736/S1973-9087.17.04940-1. Epub 2017 Nov 29.


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.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Botulinum Toxins, Type A / administration & dosage
  • Botulinum Toxins, Type A / therapeutic use*
  • Cerebral Palsy / physiopathology*
  • Child
  • Combined Modality Therapy
  • Gait
  • Humans
  • Muscle Spasticity / drug therapy*
  • Neuromuscular Agents / administration & dosage
  • Neuromuscular Agents / therapeutic use*
  • Physical Therapy Modalities*
  • Range of Motion, Articular


  • Neuromuscular Agents
  • Botulinum Toxins, Type A