Table 1

Inclusion and exclusion criteria

Inclusion criteria

Exclusion criteria


Children must have:

1. a clinical diagnosis of unilateral or bilateral spastic CP

2. an age between 4-12 years old

3. at least 0° ankle dorsiflexion with extended knee (physical examination)

4. a GMFCS class I, II or III

5. has been treated for reduced ankle dorsiflexion (< 5° dorsiflexion) before the start of the study by:

a. and/or serial casting at least 3 months ago

b. and/or botulinum toxin A injections in the Gastrocnemius and/or Soleus muscle at least 6 months ago

c. orthotic management in rest with a knee-ankle-foot orthosis to prevent for decreasing ankle dorsiflexion

6. a stable social family situation

Children must not:

1. have had surgery of the Gastrocnemius and/or Soleus muscle

2. have had Selective Dorsal Rhizotomy

3. have had Intrathecal Baclofen therapy

4. have had Botulinum toxin A treatment in the lower extremity less than 6 months ago

5. have had casting of the lower extremity less than 3 months ago

6. have knee contractures (less than 0° knee extension)

7. have more than 20° ankle dorsiflexion at full knee extension

8. have behavioural problems (like severe mental retardation)

9. have significant sleeping problems

10. be institutionalised

11. be suffering from co-morbidity interfering with mobility that prevents them from walking adequate distance.

12. have problems with understanding either the Dutch (for subjects in the Netherlands) or English language


Maas et al. BMC Pediatrics 2012 12:38   doi:10.1186/1471-2431-12-38

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