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The Effects of Backward Downhill Treadmill Training Following Botulinum Toxin-A Injection and Serial Casting in
Pelin Atalan Efkere1, Habip Eser Akkaya2, Kamile Uzun Akkaya1
1Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gazi University, Ankara, Türkiye.
Background:
To investigate the effects of Backward Downhill Treadmill Training (BDTT) and structured physiotherapy (SP) following botulinum toxin-A (BoNT-A) injection and serial casting in children with cerebral palsy (CP).
Methods:
The study included 17 children with CP, aged 5-10 years, who had been injected with BoNT-A into the medial gastrocnemius muscles and then followed by a serial casting protocol. Exercises including functional strengthening and stretching were applied to the children in the SP group (n = 9). The BDTT + SP group engaged in BDTT sessions in addition to SP training 3 days a week, for 6 weeks, and for 15 minutes each session. Muscle strength, range of motion, spasticity, selective motor control, gait, morphology of the gastrocnemius muscle, and activities of daily living were evaluated before and after the training. The effectiveness of the BDTT + SP programs together and SP program only was compared using Quade analysis of covariance test.
Results:
The ankle dorsiflexor muscle strength, the range of motion for dorsiflexion and hip flexion, the dynamic catch response of spasticity, and the morphological aspects of the medial gastrocnemius muscle demonstrated improvement following both BDTT + SP and SP training alone. The BDTT + SP group exhibited greater improvements in several key parameters, including strength of plantar flexors and hip abductors, gait scores, vascularization, and stiffness of the medial gastrocnemius muscle, when compared to the group taking the SP program only.
Conclusions:
BDTT, in addition to SP, was associated with greater improvements in strength and vascularization of the BoNT-A-injected muscle in children with CP compared with SP alone.
