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KMID : 0361420110350030344
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Journal of Korean Academy of Rehabilitation Medicine
2011 Volume.35 No. 3 p.344 ~ p.353
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The Effect and Complication of Botulinum Toxin Type A Injection with Serial Casting for the Treatment of Spastic Equinus Foot
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Lee Sook-Joung
Sung In-Young
Jang Dae-Hyun
Yi Jin-Hwa
Lee Jin-Ho
Ryu Ju-Seok
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Abstract
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Objective: To identify the effect of serial casting combined with Botulinum toxin type A (BTX-A) injection on spastic equinus foot.
Method: Twenty-nine children with cerebral palsy who had equinus foot were recruited from the outpatient clinic of Rehabilitation Medicine. The children were divided into 2 groups, one of which received serial casting after BTX-A injection, and the other which only received BTX-A injection. Serial casting started 3 weeks after the BTX-A injection, and was changed weekly for 3 times. Spasticity of the ankle joint was evaluated using the modified Ashworth scale (MAS), and the modifi ed Tardieu scale (MTS). Gait pattern was measured using the physician’s rating scale (PRS).
Results: Th e degree of ankle dorsifl exion and the MAS improved signifi cantly until 12 weeks following the BTX-A injection in the serial casting group (p<0.001), while the BTX-A injection-only group improved until 6 weeks following injection (p<0.05). The combined group showed a significantly greater increase in the degree of dorsifl exion compared to the BTX-A injection-only group at post-injection weeks 6 and 12 (p<0.05). Th ree children (11.5%) suff ered from foot ulcers as a complication caused by the serial casting.
Conclusion: Our study demonstrated that the eff ect of BTX-A injection with serial casting was superior and lasted longer than the effect of BTX-A injection only in patients with spastic equinus foot. We therefore recommend BTX-A injection with serial casting for the treatment of equinus foot. However, physicians must also consider the possible complications associated with serial casting.
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KEYWORD
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Cerebral palsy, Equinus foot, Botulinum toxin type A, Serial casting
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