1. www.postersession.com Cerebral Palsy is a non-progressive non- contagious, disorder that is characterized by motor conditions that cause physical disability in human development. CP is the common most cause of severe physical disability in childhood. [1] There are a number of interventions including the use of Botulinum Toxin and casts/ankle- foot orthoses (AFO). The solid AFO biomechanically controls the ankle by using a three-force system to prevent excessive ankle plantar flexion during stance. [2] The inhibitive AFO decrease spasticity by prolonged stretch and pressure on the tendons of the triceps surae muscle and toe flexors. [2] Botulinum toxin A blocks the release of acetylcholine at the neuromuscular junction. The goal of this presentation/research study is to compare the use of foot orthoses and Botulinum Toxin A at improving gait in children with Cerebral Palsy. Botulinum Toxin A Conclusions In Children with Cerebral Palsy, is the Use of Botulinum Toxin or Foot Orthoses Better at Improving Gait? Justin Klenke, Student Physical Therapist Bellarmine University DPT Forty patients with spastic diplegia or hemiplegia were enrolled. [1] Twenty two received botulinum toxin and 18 received a placebo. [1] The active drug (Botulinum Toxin) was injected into the gastrocnemius and soleus muscle groups. [1] Showed improvement in initial foot contact. [1] Forty eight percent of experiment group showed clinical improvement in video gait analysis. [1] The gross motor function measure showed statistically significant in experimental group. [1] Cost index and passive ankle dorsiflexion were not statistically significant. [1] Systematic Review that searched CINHAL, Cochrane, PEDro, EMBASE, and PubMed from 1993-2009. [3] Assessed functional outcomes on walking in children with CP. [3] Eight trials were included. [3] Those comparing use of Botulinum Toxin with Physical Therapy versus PT alone showed moderate evidence for functional outcomes (GMFM and video gait analysis). [3] 24 children with spastic CP and dynamic equines deformity. [4] Velocity, cadence, stride length, stride width, and clinical gait were assessed. [4] AFO use increased velocity and stride length. [4] No statistical significance with regards to cadence and stride width. [4] All of the patients demonstrated a toe-walk gait pattern without the AFO. [4] Nine patients had heel toe gait with the AFO’s. [4] 15 flat foot gait with the AFO’s. [4] 10 children with spastic CP. [2] Increased stride length, decreased cadence, and reduced excessive ankle plantarflexion with use of AFO’s. [2] No differences were found between the two AFO’s. [2] DAFO liked by both parents and children better. [2] 11 children with hemiplegic CP. [5] Gait analysis and energy consumption assessed. [5] AFO’s custom made with PF stop at 0 degrees. [5] AFO use improved walking speed, stride length and single leg support time compared to no AFO. [5] Double limb support significantly decreased. [5] No change in cadence. [5] DF at initial contact, midstance, and midswing showed significant increase. [5] Knee flexion at initial contact was decreased. [5] Oxygen consumption was significantly reduced with use of AFO. [5] The hinged AFO is useful in controlling dynamic equinis deformity and reducing energy expenditures of gait in children with hemiplegic spastic cerebral palsy. [5] Use of AFO’s in children with CP benefits ambulation. [4] Botulinum Toxin A use with PT improves walking in children with CP. [3] Use of Botulinum Toxin A in addition to PT and orthotics help reduce spasticity and improve functional mobility in children with spastic deplegic or hemiplegic CP. [1] Introduction Foot Orthotics Clinical Impression There are many treatment interventions for children with CP, including use of Botulinum Toxin A and AFO’s. Based on research and clinical impressions, a combination of Botulinum Toxin, AFO’s, and PT seems to be the most effective way to improve gait in children with CP. References 1.Ubhi T, Bhakta B, Ives H, Allgar V, Roussounis S. Randomised double blind placebo controlled trial of the effect of botulinum toxin on walking in cerebral palsy. Archives Of Disease In Childhood [serial online]. December 2000;83(6):481-487. Available from: CINAHL, Ipswich, MA. Accessed November 21, 2013. 2.Radtka S, Skinner S, Dixon D, Johanson M. A comparison of gait with solid, dynamic, and no ankle-foot orthoses in children with spastic cerebral palsy. Physical Therapy [serial online]. April 1997;77(4):395-409. Available from: CINAHL, Ipswich, MA. Accessed November 21, 2013. 3.Ryll U, Bastiaenen C, DE Bie R, Staal B. Effects of leg muscle botulinum toxin A injections on walking in children with spasticity-related cerebral palsy: a systematic review. Developmental Medicine & Child Neurology [serial online]. March 2011;53(3):210-216. Available from: CINAHL, Ipswich, MA. Accessed November 21, 2013. 4.Dursun E, Dursun N, Alican D. Ankle-foot orthoses: effect on gait in children with cerebral palsy. Disability & Rehabilitation [serial online]. May 10, 2002;24(7):345-347. Available from: CINAHL, Ipswich, MA. Accessed November 21, 2013. 5.Balaban B, Yasar E, Dal U, Yazi ˙ ci ˙ oglu K, Mohur H, Kalyon T. The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegic cerebral palsy. Disability & Rehabilitation [serial online]. January 30, 2007;29(2):139-144. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed November 21, 2013. http://www.massdevice.com/blogs/massdevice/does-it-get-better-surgical-outcomes-children-with- cerebral-palsy http://www.cincinnatichildrens.org/assets/0/78/847/907/2249b830-9353-4b77-9262-c893e8aa17df.jpg http://www.starmedicalllc.com/wp- content/uploads/2011/04/solid-ankle-afo.jpg Radtka S, Skinner S, Dixon D, Johanson M. A comparison of gait with solid, dynamic, and no ankle- foot orthoses in children with spastic cerebral palsy. Physical Therapy [serial online]. April 1997;77(4):395- 409. Available from: CINAHL, Ipswich, MA. Accessed November 21, 2013.