Case Report: Combination of focal vibration therapy and botulinum toxin injections to treat equinus gait in a child with unilateral spastic cerebral palsy
IntroductionFocal vibration therapy (FVT) is increasingly used in the treatment of spastic paresis. In adults, it has been shown to reduce spasticity and to increase torque production from the vibrated muscles by restoring reciprocal inhibition of antagonists, thereby improving overall gait. In chil...
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Frontiers Media S.A.
2025-02-01
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| Series: | Frontiers in Rehabilitation Sciences |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fresc.2025.1454109/full |
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| author | Christophe Boulay Christophe Boulay Christophe Boulay Jacques-Olivier Coq Morgan Sangeux Morgan Sangeux Guillaume Authier Guillaume Authier Alexis Ulian Alexis Ulian Maud Pradines Maud Pradines Marjolaine Baude Marjolaine Baude Béatrice Desnous Jean-Luc Jouve Jean-Luc Jouve Bernard Parratte Emilie Peltier Sébastien Pesenti Jean-Michel Gracies Jean-Michel Gracies |
| author_facet | Christophe Boulay Christophe Boulay Christophe Boulay Jacques-Olivier Coq Morgan Sangeux Morgan Sangeux Guillaume Authier Guillaume Authier Alexis Ulian Alexis Ulian Maud Pradines Maud Pradines Marjolaine Baude Marjolaine Baude Béatrice Desnous Jean-Luc Jouve Jean-Luc Jouve Bernard Parratte Emilie Peltier Sébastien Pesenti Jean-Michel Gracies Jean-Michel Gracies |
| author_sort | Christophe Boulay |
| collection | DOAJ |
| description | IntroductionFocal vibration therapy (FVT) is increasingly used in the treatment of spastic paresis. In adults, it has been shown to reduce spasticity and to increase torque production from the vibrated muscles by restoring reciprocal inhibition of antagonists, thereby improving overall gait. In children with spastic cerebral palsy (CP), FVT has also been suggested to reduce spasticity, increase torque production and improve gait function, but evidence is limited.MethodsWe report the case of a child with unilateral spastic CP (USCP) and equinus gait (GFMCS II level) with (i) ankle dorsiflexor paresis, (ii) ankle plantar flexor overactivity, especially in gastrosoleus complex and peroneus longus, (iii) spastic myopathy, affecting gastrosoleus complex in particular, and (iv) calf pain seemingly related to muscle overactivity. The child was treated with a two-month program of alternating dorsiflexor and plantar flexor focal vibration therapy (FVT) and botulinum neurotoxin A (BoNT-A) injections into plantar flexors, alongside conventional physiotherapy.Results and discussionClinical evaluations during the two-month program showed (i) improved walking speed (ii) decreased ankle dorsiflexor paresis and ankle plantar flexor overactivity, especially spastic co-contraction and spasticity, (iii) improved passive extensibility in plantar flexors, and (iv) reduced pain. This is the first report of the combination of FVT and BoNT-A injections having promising effects on equinus gait in USCP. |
| format | Article |
| id | doaj-art-8f85a432f9b746b9a9f2c9f7b4d2df39 |
| institution | Kabale University |
| issn | 2673-6861 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Rehabilitation Sciences |
| spelling | doaj-art-8f85a432f9b746b9a9f2c9f7b4d2df392025-02-06T07:10:19ZengFrontiers Media S.A.Frontiers in Rehabilitation Sciences2673-68612025-02-01610.3389/fresc.2025.14541091454109Case Report: Combination of focal vibration therapy and botulinum toxin injections to treat equinus gait in a child with unilateral spastic cerebral palsyChristophe Boulay0Christophe Boulay1Christophe Boulay2Jacques-Olivier Coq3Morgan Sangeux4Morgan Sangeux5Guillaume Authier6Guillaume Authier7Alexis Ulian8Alexis Ulian9Maud Pradines10Maud Pradines11Marjolaine Baude12Marjolaine Baude13Béatrice Desnous14Jean-Luc Jouve15Jean-Luc Jouve16Bernard Parratte17Emilie Peltier18Sébastien Pesenti19Jean-Michel Gracies20Jean-Michel Gracies21Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children’s Hospital, Marseille, FranceInstitut des Sciences du Mouvement (ISM), Equipe DynamiCC, UMR 7287 CNRS/Aix Marseille Université, Marseille, FranceAP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, FranceInstitut des Sciences du Mouvement (ISM), Equipe DynamiCC, UMR 7287 CNRS/Aix Marseille Université, Marseille, FranceGait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children’s Hospital, Marseille, FranceDepartment of Orthopaedics, University Children’s Hospital, Basel, SwitzerlandGait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children’s Hospital, Marseille, FranceInstitut des Sciences du Mouvement (ISM), Equipe DynamiCC, UMR 7287 CNRS/Aix Marseille Université, Marseille, FranceGait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children’s Hospital, Marseille, FranceInstitut des Sciences du Mouvement (ISM), Equipe DynamiCC, UMR 7287 CNRS/Aix Marseille Université, Marseille, FranceAP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, FranceUR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, FranceAP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, FranceUR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, FrancePediatric Neurology Department, Timone Children’s Hospital, Marseille, FranceGait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children’s Hospital, Marseille, FranceInstitut des Sciences du Mouvement (ISM), Equipe DynamiCC, UMR 7287 CNRS/Aix Marseille Université, Marseille, FranceGait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children’s Hospital, Marseille, FranceGait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children’s Hospital, Marseille, FranceGait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children’s Hospital, Marseille, FranceAP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, FranceUR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, FranceIntroductionFocal vibration therapy (FVT) is increasingly used in the treatment of spastic paresis. In adults, it has been shown to reduce spasticity and to increase torque production from the vibrated muscles by restoring reciprocal inhibition of antagonists, thereby improving overall gait. In children with spastic cerebral palsy (CP), FVT has also been suggested to reduce spasticity, increase torque production and improve gait function, but evidence is limited.MethodsWe report the case of a child with unilateral spastic CP (USCP) and equinus gait (GFMCS II level) with (i) ankle dorsiflexor paresis, (ii) ankle plantar flexor overactivity, especially in gastrosoleus complex and peroneus longus, (iii) spastic myopathy, affecting gastrosoleus complex in particular, and (iv) calf pain seemingly related to muscle overactivity. The child was treated with a two-month program of alternating dorsiflexor and plantar flexor focal vibration therapy (FVT) and botulinum neurotoxin A (BoNT-A) injections into plantar flexors, alongside conventional physiotherapy.Results and discussionClinical evaluations during the two-month program showed (i) improved walking speed (ii) decreased ankle dorsiflexor paresis and ankle plantar flexor overactivity, especially spastic co-contraction and spasticity, (iii) improved passive extensibility in plantar flexors, and (iv) reduced pain. This is the first report of the combination of FVT and BoNT-A injections having promising effects on equinus gait in USCP.https://www.frontiersin.org/articles/10.3389/fresc.2025.1454109/fullchildren with cerebral palsyequinusfocal vibration therapybotulinum neurotoxin Afive-step assessment |
| spellingShingle | Christophe Boulay Christophe Boulay Christophe Boulay Jacques-Olivier Coq Morgan Sangeux Morgan Sangeux Guillaume Authier Guillaume Authier Alexis Ulian Alexis Ulian Maud Pradines Maud Pradines Marjolaine Baude Marjolaine Baude Béatrice Desnous Jean-Luc Jouve Jean-Luc Jouve Bernard Parratte Emilie Peltier Sébastien Pesenti Jean-Michel Gracies Jean-Michel Gracies Case Report: Combination of focal vibration therapy and botulinum toxin injections to treat equinus gait in a child with unilateral spastic cerebral palsy Frontiers in Rehabilitation Sciences children with cerebral palsy equinus focal vibration therapy botulinum neurotoxin A five-step assessment |
| title | Case Report: Combination of focal vibration therapy and botulinum toxin injections to treat equinus gait in a child with unilateral spastic cerebral palsy |
| title_full | Case Report: Combination of focal vibration therapy and botulinum toxin injections to treat equinus gait in a child with unilateral spastic cerebral palsy |
| title_fullStr | Case Report: Combination of focal vibration therapy and botulinum toxin injections to treat equinus gait in a child with unilateral spastic cerebral palsy |
| title_full_unstemmed | Case Report: Combination of focal vibration therapy and botulinum toxin injections to treat equinus gait in a child with unilateral spastic cerebral palsy |
| title_short | Case Report: Combination of focal vibration therapy and botulinum toxin injections to treat equinus gait in a child with unilateral spastic cerebral palsy |
| title_sort | case report combination of focal vibration therapy and botulinum toxin injections to treat equinus gait in a child with unilateral spastic cerebral palsy |
| topic | children with cerebral palsy equinus focal vibration therapy botulinum neurotoxin A five-step assessment |
| url | https://www.frontiersin.org/articles/10.3389/fresc.2025.1454109/full |
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