Gait Rehabilitation in Diplegic Children

Gait Rehabilitation in Ambulant Diplegic Children Using BOTOX and Ankle Weights

Background: Standing and walking serve an individual's basic need to move from place to place, and both are the most common activities that people do on a daily basis.

Aim: to investigate the combined effect of botulinum toxin A (BoNT-A) injection and ankle weight on the gait of diplegic children who are using Ankle foot orthoses.

Methods: Sixty children with spastic diplegia were included in this prospective, controlled trial. Children were divided into three groups, each with 20 patients: Group 1 received classical gait rehabilitation; Group 2 received the same gait training while adding ankle weight ; and Group 3 received the same as group 2 plus botulinum toxin injection. The Modified Ashworth Scale (MAS),knee range-of-motion measures, and Hoffman /Myogenic reflex ratio were used to examine patients before the commencement of treatment and post-treatment.

Inclusion Criteria:

• diagnosed as spastic diplegia.
• They were able to follow simple verbal instructions.
• The use of Ankle Foot Orthoses.
• Spasticity grade of 1+ or 2 in both calf and hamstring muscles according to modified Ashworth's scale (MAS).
• level I or II on the Gross Motor Function Classification System (GMFCS).

Exclusion Criteria:

• fixed contractures or deformities in the lower limbs.
• surgical orthopedic intervention.
• Botulinum A injection or use of neuromuscular blockers in the previous 6 months before the start of study.