How does treadmill training contribute to botulinum toxin application plus routine physical therapy in ambulatory children with spastic bilateral cerebral palsy? A randomized controlled trial.

Botulinum toxin injections are widely used to reduce spasticity in children with cerebral palsy, but the injection itself is only part of the picture: therapy afterward is meant to help the muscles translate that reduced stiffness into better movement. This trial asked whether adding treadmill walking to standard physical therapy after the injections would do more than standard therapy alone. Thirty children with spastic bilateral cerebral palsy, who could walk but with some limitations, were randomly assigned to receive either routine physical therapy or the same therapy plus eight weeks of twice-weekly treadmill sessions.

Both groups gained muscle strength, but the treadmill group showed additional gains in hip muscle strength, better selective control of ankle movement, faster walking speed, longer steps, and improved overall mobility compared with the control group. The finding is interesting because it suggests treadmill training may add functional value beyond the injections and standard care, though the trial was small and only followed children for eight weeks, so how long these differences last is unknown.

If your child has cerebral palsy and has had botulinum toxin injections to ease muscle stiffness, you may wonder what kind of therapy afterward makes the biggest difference. This study looked at children with spastic cerebral palsy affecting both legs who could walk, comparing those who did their usual physical therapy after the injections with those who also did eight weeks of treadmill walking, twice a week for twenty minutes. Both groups got stronger in their hip, knee, and ankle muscles.

But the children who also did treadmill training showed extra benefits: stronger hip muscles, better control over their ankle movements, faster walking, longer steps, and improved everyday mobility, compared to the group that didn't do treadmill training. This is encouraging for thinking about what might help after injections, but it comes from a small study of just thirty children followed for only eight weeks. That means we don't yet know whether these improvements last longer or how they might look in bigger groups of children.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This randomised controlled trial (NCT03580174) enrolled 30 ambulatory children with spastic bilateral cerebral palsy (GMFCS II-III), comparing routine physical therapy after multilevel botulinum toxin injection with the same therapy plus eight weeks of treadmill training (20 minutes, twice weekly). Outcomes included handheld dynamometry, selective control assessment of the lower extremity, temporospatial gait parameters, and the Pediatric Evaluation of Disability Inventory. Both groups showed within-group increases in hip, knee, and ankle muscle strength after eight weeks (p<0.05), so strength gains alone cannot be attributed to treadmill training.

Between-group analysis, however, favoured the treadmill group for hip flexor/extensor strength (p<0.05, effect size ≥0.50), ankle selective motor control (p<0.01, effect size 1.17), walking speed (p<0.01, effect size 2.60), step length (p<0.01, effect size 1.32), and mobility on the Pediatric Evaluation of Disability Inventory (p<0.01, effect size 1.37). The large reported effect sizes are notable, but the sample size of 30 children and short eight-week follow-up limit confidence in durability and generalisability. No adverse events were reported in the abstract.

These findings represent short-term outcomes only, and longer-term follow-up and larger trials would be needed to establish persistence of the observed gains.