{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:31:09Z","timestamp":1792812669554,"version":"4.5.0"},"reference-count":33,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T00:00:00Z","timestamp":1771113600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Patients with cerebral palsy (CP) experience complex gait disorders that change with age, leading to reduced activity and social participation. This study aimed to analyse how gait patterns developed over five years and to examine the relationships between the Observational Gait Scale (OGS), Amsterdam Gait Classification (AGC), Gross Motor Function Classification System (GMFCS), and the Functional Mobility Scale (FMS) at 5 and 50 m (FMS 5\/50) during treatment. This retrospective, single-centre observational study involved annual assessments over a five-year period, which were analysed. Patients underwent a rehabilitation programme including physiotherapy, orthotics, multilevel botulinum toxin type A injections (BoNT-A), and serial casting. Data regarding BoNT-A treatment, casting, physiotherapy, orthoses, GMFCS levels, and FMS 5\/50 scores were obtained from medical records. OGS and AGC were evaluated through two-plane clinical video recordings conducted in the same gait laboratory for all children. A cohort of 200 pediatric subjects (120 boys and 80 girls) diagnosed with bilateral cerebral palsy, predominantly classified as GMFCS II (48%) and III (36%), was analyzed. The average initial age was 32.23 months (\u00b16.96), and GMFCS levels improved in 33. 5% of children and worsened in 2% (p &lt; 0.001). Improvements were observed in 50% of children with GMFCS III and 40% with GMFCS IV levels. FMS 5 and 50 improved by 54% and 52%, respectively. OGS scores showed improvement in 74% and 76% of patients, respectively, while deterioration was observed in 5% and 7% for the right and left lower limbs, respectively. Most changes in OGS scores ranged from 1 to 4 points. A negative correlation was found between OGS and GMFCS (p &lt; 0.001), and a positive correlation was found between OGS scores and FMS 5 and FMS 50 (p &lt; 0.001). Additionally, significant relationships were identified between AGC and GMFCS, as well as FMS at 5 and 50 m. Complex gait disorders identified by the AGC are associated with higher GMFCS E&amp;R scores and lower FMS scores. During the five-year follow-up, relationships were observed among GMFCS, FMS, OGS, and AGC. Our findings indicate that integrated treatment has a positive effect on functional mobility and gait patterns in patients with CP.<\/jats:p>","DOI":"10.3390\/toxins18020100","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T08:38:39Z","timestamp":1771231119000},"page":"100","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Relationship Between the Gross Motor Function Classification System, Functional Mobility Scale, Observational Gait Scale, and the Amsterdam Gait Classification in Children with Cerebral Palsy During Long-Term Treatment with Botulinum Toxin Injections and Combined Integrated, Intensive Rehabilitation"],"prefix":"10.3390","volume":"18","author":[{"given":"Weronika","family":"Pyrzanowska","sequence":"first","affiliation":[{"name":"Health Sciences Department, The Maria Grzegorzewska University, 02-353 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Chro\u015bci\u0144ska-Krawczyk","sequence":"additional","affiliation":[{"name":"Department of Children\u2019s Neurology, University Children\u2019s Hospital, 20-093 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigar","family":"Dursun","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kocaeli University, 41001 Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2028-7024","authenticated-orcid":false,"given":"Marcin","family":"Bonikowski","sequence":"additional","affiliation":[{"name":"Health Sciences Department, The Maria Grzegorzewska University, 02-353 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1017\/S001216220500112X","article-title":"Executive Committee for the Definition of Cerebral Palsy. Proposed definition and classification of cerebral palsy, April 2005","volume":"47","author":"Bax","year":"2005","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1111\/j.1469-8749.2010.03844.x","article-title":"Distribution of motor types in cerebral palsy: How do registry data compare?","volume":"53","author":"Reid","year":"2011","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Graham, H.K., Rosenbaum, P., Paneth, N., Dan, B., Lin, J.P., Damiano, D.L., Becher, J.G., Gaebler-Spira, D., Colver, A., and Reddihough, D.S. (2016). Cerebral palsy. Nat. Rev. Dis. Primers, 2.","DOI":"10.1038\/nrdp.2015.82"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"158","DOI":"10.5603\/PJNNS.a2021.0032","article-title":"Safety and efficacy of Botulinum toxin type A preparations in cerebral palsy\u2014An evidence-based review","volume":"55","author":"Bonikowski","year":"2021","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_5","first-page":"161","article-title":"The effects of quantitative gait assessment and botulinum toxin a on musculoskeletal surgery in children with cerebral palsy","volume":"88","author":"Molenaers","year":"2006","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1016\/j.apmr.2006.08.342","article-title":"The combined effect of lower-limb multilevel botulinum toxin type a and comprehensive rehabilitation on mobility in children with cerebral palsy: A randomized clinical trial","volume":"87","author":"Scholtes","year":"2006","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"183","DOI":"10.5603\/PJNNS.a2022.0081","article-title":"Functional improvement of young children with cerebral palsy treated with integrated\/intensive rehabilitation and botulinum toxin injections","volume":"57","author":"Bonikowski","year":"2023","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_8","first-page":"107","article-title":"GMFCS level improvement in children with cerebral palsy treated with repeat botulinum toxin injections and intensive rehabilitation: A retrospective study","volume":"15","author":"Dursun","year":"2022","journal-title":"J. Pediatr. Rehabil. Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Pyrzanowska, W., Chro\u015bci\u0144ska-Krawczyk, M., and Bonikowski, M. (2025). Long-Term Improvement of Gait Kinematics in Young Children with Cerebral Palsy Treated with Botulinum Toxin Injections and Integrated\/Intensive Rehabilitation: A 5-Year Retrospective Observational Study. Toxins, 17.","DOI":"10.3390\/toxins17030142"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.ridd.2018.06.013","article-title":"The natural history of crouch gait in bilateral cerebral palsy: A systematic review","volume":"80","author":"Horgan","year":"2018","journal-title":"Res. Dev. Disabil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1111\/j.1469-8749.2007.00603.x","article-title":"The Functional Mobility Scale: Ability to detect change following single event multilevel surgery","volume":"49","author":"Harvey","year":"2007","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"511","DOI":"10.3109\/17453674.2015.1011927","article-title":"Gait improvement surgery in ambulatory children with diplegic cerebral palsy","volume":"86","author":"Terjesen","year":"2015","journal-title":"Acta Orthop."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2181","DOI":"10.1016\/j.jbiomech.2004.09.036","article-title":"Muscular contributions to hip and knee extension during the single limb stance phase of normal gait: A framework for investigating the causes of crouch gait","volume":"38","author":"Arnold","year":"2005","journal-title":"J. Biomech."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.jbmt.2024.12.028","article-title":"Gait profiles of children and adolescents with cerebral palsy according to their gross motor levels","volume":"42","author":"Mendes","year":"2025","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.ejpn.2022.11.009","article-title":"Relationship between kinematic gait quality and caregiver-reported everyday mobility in children and youth with spastic Cerebral Palsy","volume":"42","author":"Schupfinger","year":"2023","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.pmr.2009.04.002","article-title":"Understanding function and other outcomes in cerebral palsy","volume":"20","year":"2009","journal-title":"Phys. Med. Rehabil. Clin. N. Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1001\/jama.288.11.1357","article-title":"Prognosis for gross motor function in cerebral palsy: Creation of motor development curves","volume":"288","author":"Rosenbaum","year":"2002","journal-title":"JAMA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1080\/16501970310018305","article-title":"Musculoskeletal pain in adults with cerebral palsy compared with the general population","volume":"36","author":"Jahnsen","year":"2004","journal-title":"J. Rehabil. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1097\/01241398-200209000-00020","article-title":"Natural progression of gait in children with cerebral palsy","volume":"22","author":"Bell","year":"2002","journal-title":"J. Pediatr. Orthop."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1111\/j.1469-8749.2001.tb00755.x","article-title":"Functional status of adults with cerebral palsy and implications for treatment of children","volume":"43","author":"Bottos","year":"2001","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/j.1469-8749.2004.tb00457.x","article-title":"Short-term outcome of multilevel surgical intervention in spastic diplegic cerebral palsy compared with the natural history","volume":"46","author":"Gough","year":"2004","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1017\/S001216220700014X.x","article-title":"Motor function following multilevel botulinum toxin type A treatment in children with cerebral palsy","volume":"49","author":"Desloovere","year":"2007","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.pediatrneurol.2006.09.010","article-title":"Effect of multilevel botulinum toxin a and comprehensive rehabilitation on gait in cerebral palsy","volume":"36","author":"Scholtes","year":"2007","journal-title":"Pediatr. Neurol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/s11832-013-0511-x","article-title":"Botulinum toxin A treatment of the lower extremities in children with cerebral palsy","volume":"7","author":"Molenaers","year":"2013","journal-title":"J. Child Orthop."},{"key":"ref_25","first-page":"677","article-title":"An evaluator-blinded randomized controlled trial evaluating therapy effects and prognostic factors for a general and an individually defined physical therapy program in ambulant children with bilateral spastic cerebral palsy","volume":"51","author":"Franki","year":"2015","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1111\/j.1469-8749.2008.03250.x","article-title":"Walking function, pain and fatigue in adults with cerebral palsy: A 7-year follow-up study","volume":"51","author":"Opheim","year":"2009","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1177\/0260106018758519","article-title":"Goal setting for weight-related behavior change in children: An exploratory study","volume":"24","author":"Fisher","year":"2018","journal-title":"Nutr. Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1093\/ptj\/80.6.598","article-title":"A multivariate model of determinants of motor change for children with cerebral palsy","volume":"80","author":"Bartlett","year":"2000","journal-title":"Phys. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1111\/j.1469-8749.2008.02037.x","article-title":"How do changes in body functions and structures, activity, and participation relate in children with cerebral palsy?","volume":"50","author":"Wright","year":"2008","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1111\/j.1469-8749.2008.03089.x","article-title":"Content validity of the expanded and revised Gross Motor Function Classification System","volume":"50","author":"Palisano","year":"2008","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1097\/01241398-200409000-00011","article-title":"The Functional Mobility Scale (FMS)","volume":"24","author":"Graham","year":"2004","journal-title":"J. Pediatr. Orthop."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/j.1469-8749.2003.tb00852.x","article-title":"Reliability and validity of the Observational Gait Scale in children with spastic diplegia","volume":"45","author":"Mackey","year":"2003","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1097\/00008526-200212000-00004","article-title":"Pediatric Rehabilitation in Children with Cerebral Palsy: General Management, Classification of Motor Disorders","volume":"14","author":"Becher","year":"2002","journal-title":"JPO J. Prosthet. Orthot."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/18\/2\/100\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T08:47:17Z","timestamp":1771231637000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/18\/2\/100"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,15]]},"references-count":33,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["toxins18020100"],"URL":"https:\/\/doi.org\/10.3390\/toxins18020100","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,15]]}}}