Shockwaves Therapy and Botulinum Toxin for the Treatment of Spasticity in Patients With Cerebral Palsy. A Cross Over RCT

Outcome Measures:

The primary outcome will be to measure spasticity with passive range of motion of the foot (pROM) by muscular extensibility and its traction reflex using goniometryIt will be assessed at baseline before the treatment, as well as after 3 weeks, 2 months, 3 months, after the washout period (3months), 3 months and 3 weeks, 5 months and 6 months, when the end the intervention.

Secondary outcome includes: 1) Pain will be assessed with Visual Analog Scale (VAS) after the first application of each therapy. 2) Ascertain if the type of Gross Motor Functional Classification System (GMFCS) has an influence on the improvement of these two treatments; 3) Assess whether infiltration of Botulinum Toxin in other muscle groups have influence on the results of study; and 4) Undergo a qualitative registration to know the perception and experience that patient/family will have during this study, through a satisfaction questionnaire.

Inclusion criteria

• Age between 5 and 55 years
• Any level of GMFCS (Gross Motor Function Classification System)
• The patient consent to participate in the study
• Diagnosis of spastic cerebral palsy
• Triceps Surae spasticity in them.
• The dynamic foot deformity.
• Extensibility between 0 ° and 20 ° in dorsal flexion passive way.
• Do not be diagnosed important cutaneous alterations.

Exclusion criteria

• Associate neuromuscular disease.
• Surgical Intervention to augment the balance articulate and / or reduce the spasticity in the last six months.
• Fixed foot deformity.
• Etiology of factors:

or genetic bone disorders / disturbances soft parts. Position with anomalies or alterations in soft parts or bone alterations (mechanical).

• Unable to follow the treatment.
• Allergy to botulinum toxin.