Clinical Effects of Botulinum Toxin Type A Combined With Extracorporeal Shockwave Therapy on Plantar Flexor Spasticity in Cerebral Palsy

OBJECTIVE: To compare Botulinum Toxin Type A (BoNT-A) alone versus BoNT-A combined with extracorporeal shockwave therapy (ESWT) on spasticity, functional mobility, pain, and range of motion in children with spastic cerebral palsy (CP). DESIGN: Single-blind randomized controlled trial of 20 children with spastic CP. All participants received BoNT-A injections into the ankle plantar flexors; the combination group additionally received three weekly ESWT sessions. Spasticity (MAS, MTS), functional mobility (MTUG), pain (FPS-R), and passive ankle dorsiflexion range of motion (PROM) were assessed at baseline and follow-up. RESULTS: At 12 weeks, the primary endpoint (MAS* of the plantar flexor muscle with the highest baseline MAS score) was numerically lower with BoNT-A plus ESWT than with BoNT-A alone, although the between-group difference was not statistically significant. Between-group differences in MTS, MTUG, FPS-R, and PROM were also nonsignificant. Sustained within-group improvements in spasticity, functional mobility, and pain were observed with combined treatment, although these findings did not establish superiority. CONCLUSION: Combined BoNT-A and ESWT was associated with sustained improvements in several clinical outcomes; however, superiority over BoNT-A alone was not demonstrated for the primary endpoint. Larger trials are warranted to investigate the potential additional benefits of ESWT.