{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:29:52Z","timestamp":1790634592681,"version":"4.1.0"},"reference-count":41,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2013,1,11]],"date-time":"2013-01-11T00:00:00Z","timestamp":1357862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Botulinum toxin injections may significantly improve lower limb kinematics in gait of children with spastic forms of cerebral palsy. Here we aimed to analyze the effect of lower limb botulinum toxin injections on trunk postural control and lower limb intralimb (intersegmental) coordination in children with spastic diplegia or spastic hemiplegia (GMFCS I or II). We recorded tridimensional trunk kinematics and thigh, shank and foot elevation angles in fourteen 3\u201312 year-old children with spastic diplegia and 14 with spastic hemiplegia while walking either barefoot or with ankle-foot orthoses (AFO) before and after botulinum toxin infiltration according to a management protocol. We found significantly greater trunk excursions in the transverse plane (barefoot condition) and in the frontal plane (AFO condition). Intralimb coordination showed significant differences only in the barefoot condition, suggesting that reducing the degrees of freedom may limit the emergence of selective coordination. Minimal relative phase analysis showed differences between the groups (diplegia and hemiplegia) but there were no significant alterations unless the children wore AFO. We conclude that botulinum toxin injection in lower limb spastic muscles leads to changes in motor planning, including through interference with trunk stability, but a combination of therapies (orthoses and physical therapy) is needed in order to learn new motor strategies.<\/jats:p>","DOI":"10.3390\/toxins5010093","type":"journal-article","created":{"date-parts":[[2013,1,11]],"date-time":"2013-01-11T11:16:17Z","timestamp":1357902977000},"page":"93-105","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Influence of Botulinum Toxin Therapy on Postural Control and Lower Limb Intersegmental Coordination in Children with Spastic Cerebral Palsy"],"prefix":"10.3390","volume":"5","author":[{"given":"Marc","family":"Degelaen","sequence":"first","affiliation":[{"name":"Centre d'Analyse du Mouvement, H\u00f4pital Brugmann, Universit\u00e9 Libre de Bruxelles (ULB), Brussels B-1020, Belgium"},{"name":"Revalidatie Ziekenhuis Inkendaal, Vlezenbeek B-1602, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludo","family":"De Borre","sequence":"additional","affiliation":[{"name":"Centre d'Analyse du Mouvement, H\u00f4pital Brugmann, Universit\u00e9 Libre de Bruxelles (ULB), Brussels B-1020, Belgium"},{"name":"Universitaire des Enfants Reine Fabiola, Universit\u00e9 Libre de Bruxelles (ULB),  Brussels B-1020, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Kerckhofs","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Research, Vrije Universiteit Brussel (VUB), Brussels B-1020, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"De Meirleir","sequence":"additional","affiliation":[{"name":"Universitair Ziekenhuis Vrije Universiteit Brussel (VUB), Brussels B-1020, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald","family":"Buyl","sequence":"additional","affiliation":[{"name":"Dienst Biostatistiek en Informatica, Faculteit Geneeskunde en Farmacie, Vrije Universiteit Brussel (VUB), Brussels B-1020, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Cheron","sequence":"additional","affiliation":[{"name":"Unit\u00e9 de Recherche de Neurophysiologie et de Biom\u00e9canique du. Mouvement (CP 168), Facult\u00e9 des Sciences de la Motricit\u00e9, Universit\u00e9 Libre de Bruxelles (ULB), Brussels B-1070, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Dan","sequence":"additional","affiliation":[{"name":"Centre d'Analyse du Mouvement, H\u00f4pital Brugmann, Universit\u00e9 Libre de Bruxelles (ULB), Brussels B-1020, Belgium"},{"name":"Universitaire des Enfants Reine Fabiola, Universit\u00e9 Libre de Bruxelles (ULB),  Brussels B-1020, Belgium"},{"name":"Unit\u00e9 de Recherche de Neurophysiologie et de Biom\u00e9canique du. Mouvement (CP 168), Facult\u00e9 des Sciences de la Motricit\u00e9, Universit\u00e9 Libre de Bruxelles (ULB), Brussels B-1070, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2013,1,11]]},"reference":[{"key":"ref_1","first-page":"8","article-title":"A report: The definition and classification of cerebral palsy","volume":"109","author":"Rosenbaum","year":"2007","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1111\/j.1651-2227.2005.tb03071.x","article-title":"The changing panorama of cerebral palsy in Sweden. IX. Prevalence and origin in the birth-year period 1995-1998","volume":"3","author":"Himmelmann","year":"2005","journal-title":"Acta Paediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.mporth.2009.05.003","article-title":"The management of spastic equinus in cerebral palsy","volume":"23","author":"Cobeljic","year":"2009","journal-title":"Orthop. Trauma"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/S0966-6362(99)00054-5","article-title":"Recommendations for the use of botulinum toxin type A in the management of cerebral palsy","volume":"11","author":"Graham","year":"2000","journal-title":"Gait Posture"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/0966-6362(95)01054-8","article-title":"Injection of botulinum A toxin into the gastrocnemius muscle of patients with cerebral palsy: A 3-dimensional motion analysis study","volume":"4","author":"Sutherland","year":"1996","journal-title":"Gait Posture"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S0031-9406(05)60153-8","article-title":"Botulinum toxin type A in ambulant children with cerebral palsy","volume":"89","author":"Mackey","year":"2003","journal-title":"Physiotherapy"},{"key":"ref_7","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_8","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.gaitpost.2009.04.003","article-title":"The effect of botulinum toxin injections on gait control in spastic stroke patients presenting with a stiff-knee gait","volume":"30","author":"Bleyenheuft","year":"2009","journal-title":"Gait Posture"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/S0887-8994(97)00164-1","article-title":"Use of botulinum toxin injection in 17 children with spastic cerebral palsy","volume":"18","author":"Wong","year":"1998","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.ejpn.2009.09.005","article-title":"The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy","volume":"14","author":"Heinen","year":"2010","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1016\/0959-4388(94)90137-6","article-title":"Postural control system","volume":"4","author":"Massion","year":"1994","journal-title":"Curr. Opin. Neurobiol."},{"key":"ref_12","first-page":"727","article-title":"Periventricular leukomalacia and preterm birth have a detrimental effect on postural adjustments","volume":"122","author":"Brogren","year":"1996","journal-title":"Brain"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1017\/S0012162205000605","article-title":"Development of postural adjustments in sitting position during the first half year of life","volume":"47","author":"Hedberg","year":"2005","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1155\/NP.2005.99","article-title":"Development of postural control during the first 18 months of life","volume":"12","year":"2005","journal-title":"Neural Plast."},{"key":"ref_15","unstructured":"Brogren Carlberg, E., and Hadders-Algra, M. (2008). Postural Control: A key Issue in Developmental Disorders, Wiley-Blackwell."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/S0149-7634(97)00048-1","article-title":"Development of postural responses during standing in healthy children and children with spastic diplegia","volume":"22","author":"Woollacott","year":"1998","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1177\/0309364611429855","article-title":"The effect of floor reaction ankle foot orthosis on postural control in children with spastic cerebral palsy","volume":"36","author":"Bahramizadeh","year":"2012","journal-title":"Prosthet. Orthot. Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/s11832-007-0055-z","article-title":"The effect of community-prescribed ankle-foot orthoses on gait parameters in children with spastic cerebral palsy","volume":"1","author":"Hayek","year":"2007","journal-title":"J. Child Orthop."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1080\/17483100600876740","article-title":"The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegic cerebral palsy","volume":"29","author":"Balaban","year":"2007","journal-title":"Disabil. Rehabil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S98","DOI":"10.1016\/j.gaitpost.2006.11.121","article-title":"Effect of ankle foot orthoses on 3D trunk and pelvic motion during gait in children with CP","volume":"24","author":"Molenaers","year":"2006","journal-title":"Gait Posture"},{"key":"ref_21","first-page":"171","article-title":"Effect of ankle-foot orthoses on trunk sway and lower limb intersegmental coordination in children with bilateral cerebral palsy","volume":"5","author":"Degelaen","year":"2012","journal-title":"J. Ped. Rehabil. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/S0966-6362(99)00014-4","article-title":"Kinematic compensations as children reciprocally ascend and descend stairs with unilateral and bilateral solid AFOs","volume":"9","author":"Nahorniak","year":"1999","journal-title":"Gait Posture"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1868","DOI":"10.1152\/jn.1998.80.4.1868","article-title":"Motor patterns for human gait: Backward versus forward locomotion","volume":"80","author":"Grasso","year":"1998","journal-title":"J. Neurophysiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/S0304-3940(00)00778-3","article-title":"Effect of intrathecal baclofen on gait control in human hereditary spastic paraparesis","volume":"208","author":"Dan","year":"2000","journal-title":"Neurosci. Lett."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.gaitpost.2011.12.017","article-title":"Planar covariation of elevation angles in prosthetic gait","volume":"35","author":"Leurs","year":"2012","journal-title":"Gait Posture"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1007\/s002210000663","article-title":"Development of a kinematic coordination pattern in toddler locomotion: Planar covariation","volume":"137","author":"Cheron","year":"2001","journal-title":"Exp. Brain Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1152\/jn.1998.79.4.2155","article-title":"Kinematic coordination in human gait: Relation to mechanical energy cost","volume":"79","author":"Bianchi","year":"1998","journal-title":"J. Neurophysiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1097\/01241398-199905000-00015","article-title":"Role of exercise testing in the functional assessment of cerebral palsy children after Botulinum A toxin injection","volume":"19","author":"Massin","year":"1999","journal-title":"J. Pediatr. Orthop."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1097\/PHM.0b013e31823caae1","article-title":"Botulinum toxin A treatment in children with cerebral palsy: Its effects on walking and energy expenditure","volume":"91","author":"Balaban","year":"2012","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.gaitpost.2008.07.007","article-title":"The effect of lower extremity selective voluntary motor control on interjoint coordination during gait in children with spastic diplegic cerebral palsy","volume":"29","author":"Fowler","year":"2009","journal-title":"Gait Posture"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1111\/j.1469-8749.2004.tb01021.x","article-title":"Motor impairments in young children with cerebral palsy: Relationship to gross motor function and everyday activities","volume":"46","year":"2004","journal-title":"Dev. Med. Child. Neur."},{"key":"ref_32","first-page":"163","article-title":"Effect of ankle-foot orthoses in gait in typically developing children: Development trend in segmental coordination","volume":"3","author":"Degelaen","year":"2010","journal-title":"J. Ped. Rehabil. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1007\/s11832-010-0246-x","article-title":"The use of botulinum toxin A in children with cerebral palsy with a focus on the lower limb","volume":"4","author":"Molenaers","year":"2010","journal-title":"J. Child Orthop."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1113\/jphysiol.1996.sp021539","article-title":"Kinematic determinants of human locomotion","volume":"494","author":"Borghese","year":"1996","journal-title":"J. Physiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/S0304-3940(01)01925-5","article-title":"Early emergence of temporal co-ordination of lower limb segments elevation angles in human locomotion","volume":"308","author":"Cheron","year":"2001","journal-title":"Neurosci. Lett."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3797","DOI":"10.1242\/jeb.01214","article-title":"Development of pendulum mechanism and kinematic coordination from the first unsupported steps in toddlers","volume":"207","author":"Ivanenko","year":"2004","journal-title":"J. Exp. Biol."},{"key":"ref_37","first-page":"168","article-title":"Motor patterns in walking","volume":"14","author":"Lacquaniti","year":"1999","journal-title":"News Physiol. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1152\/jn.01308.2007","article-title":"On the origin of planar covariation of elevation angles during human locomotion","volume":"99","author":"Ivanenko","year":"2008","journal-title":"J. Neurophysiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/s00221-008-1633-0","article-title":"An analytical formulation of the law of intersegmental coordination during human locomotion","volume":"193","author":"Barliya","year":"2009","journal-title":"Exp. Brain Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"11149","DOI":"10.1523\/JNEUROSCI.2644-07.2007","article-title":"Modular control of limb movements during human locomotion","volume":"27","author":"Ivanenko","year":"2007","journal-title":"J. Neurosci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1080\/00222895.1989.10735490","article-title":"Qualitative dynamics of disordered human locomotion: A preliminary investigation","volume":"4","author":"Winstein","year":"1989","journal-title":"J. Mot. Behav."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/5\/1\/93\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T21:44:13Z","timestamp":1760219053000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/5\/1\/93"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,1,11]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2013,1]]}},"alternative-id":["toxins5010093"],"URL":"https:\/\/doi.org\/10.3390\/toxins5010093","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,1,11]]}}}