SYSTEMATIC REVIEW   Free access

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