Effectiveness of a programme comprising serial casting, botulinum toxin, splinting and motor training for contracture management: a randomized controlled trial:

Objective:To determine the effectiveness of a programme comprising serial casting, botulinum toxin, splinting and motor training in contracture management.Design:A randomized trial with concealed allocation and assessor blinding, a deferred treatment cross-over design within the control group, was conducted.Setting:Inpatient Brain Injury Unit of a rehabilitation centre.Subjects:A total of 10 patients with severe acquired brain injury (13 ankles).Interventions:The intervention group received botulinum toxin and then serial casting. The control group was placed on a wait list for six weeks (control phase) and then received the same interventions as the intervention group (intervention phase). Both groups received splinting and motor training following serial casting.Main measures:The primary outcome was passive ankle dorsiflexion range. Secondary outcomes included spasticity, ankle dorsiflexor strength, Functional Independence Measure score for the walking item and walking speed.Results:The mean between-gro...