Table 3.

Summary of interventions and outcome measurements

Study	Intervention	Additional treatment	Follow-up (weeks)	Outcome measures
Baker et al. [27]	1. Placebo 2. Dysport;10–30 IU/Kg	Conventional PT and orthosis	16	- Mean of PROM of ankle DF (degrees) - Mean score of GMFM dimensions D and E (points)
Bottos et al. [28]	1. Dysport + AFO 2. Dysport + Casting - Dysport15-20 IU/Kg for both groups	Stretching, exercise, standing and gait training and provided AFO after BoNT-A	16	- Peak DF at stance (degrees)
Buckon et al. [29]	1. Control; no AFO 2. Hinged AFO, solid AFO, PLS; 6–12 h/day	No	12	- The 3D gait analysis data; kinematic (degrees) - Mean of PROM of ankle DF (degrees) - Mean score of GMFM dimensions D and E (points)
Corry et al. [9]	1. Casting; frequency of casting depended on clinical response 2. BoNT-A; 6–8 IU/Kg	No	12	- Mean composite scores of PRS (4 subscales, total 10 points/limb) - Mean of PROM of ankle DF (degrees) - The 3D gait analysis data; Mean range of ankle DF at initial contact, peak DF at stance, peak PF (degrees)
Dalvand et al. [30]	1. Control 2. Hinged AFO, solid AFO; applied after casting	NDT 3 months (3 sessions per week, 1 h daily)	12	- Mean difference of mean score of GMFM dimension D and E (points)
Dursun et al.[13]	1. PT 2. BoNT-A + PT - injected into the gastrocsoleus and tibialis posterior including hamstring and hip adductor 8–10 U/Kg	PT; Stretching, strengthening exercise, coordination training, training in daily activities	4	- Mean composite scores of CGAS (points)
Dursun et al. [31]	1. BoNT-A 2. BoNT-A + Casting injected Dysport 10–40 IU/Kg into gastrocsoleus, Casting × 3 times/week	PT (improve functional mobility, stretching) and OT; 1 h/session, 5 sessions/week	12	- Mean composite scores of OGS (points) - Mean of PROM of ankle DF (degrees)
El-Etribi et al. [20]	1. PT 2. BoNT-A + physiotherapy injected BoNT-A 3 U/Kg for hemiplegia and 6 U/Kg for diplegia into gastrocnemius	Stretching, strengthening exercise 1–1.5 h/session, 3 days/weeks	12	- Mean composite scores of PRS (6 subscales, total 14 points/limb) - Mean of PROM of ankle DF (degrees)
Flett et al. [10]	1. Casting; lasted for 4 weeks; reapplied at 2 weeks 2. BoNT-A; 4–8 U/Kg injected into gastrocsoleus	Night plaster in both groups	48	- Mean composite scores of PRS (2 subscales, total 7 points/limb) - Mean of PROM of ankle DF (degrees) - Mean score of GMFM dimension D,E (points)
Hayek et al. [32]	1. BoNT-A 2. BoNT-A + Casting injected BoNT-A into gastrocnemius (total dose of 20 U/Kg) retained casting at 2 weeks for 4 months	- Conventional PT 3 times/week - Brace	48	- Mean composite scores of OGS (points) - Mean of PROM of ankle DF + KE (degrees) - Mean of AROM of ankle DF (degrees) - Mean score of GMFM dimension D,E (points)
Koman et al. [7]	1. Placebo 2. BoNT-A; injected into medial and lateral gastrocnemius for 1 U/Kg of hemiplegia, 2 U/Kg of diplegia	Conventional PT	6	- Number of improvements of PRS (6 subscales, total 14 points/limb)
Koman et al. [23]	1. Placebo 2. BoNT-A; injected into medial and lateral gastrocnemius for 4 U/Kg of hemiplegia, 8 U/Kg of diplegia	Conventional PT	8	- Number of improvements of PRS (6 subscales, total 14 points/limb)
Mass et al. [21]	1. Control; No KAFO at night 2. KAFO for at least 6 h/night	Physical therapy; gait and standing training	48	- Mean of PROM of ankle DF (degrees)
Radtka et al. [33]	1. Control; no AFO 2. Orthosis; solid AFO	8 subjects received PT	4	- Mean range of ankle DF at initial contact and mid-stance (degrees)
Radtka et al. [34]	1. Control; no AFO 3. Orthosis; solid and hinged AFO	Preventing	4	- Mean range of ankle DF at initial contact, mid-stance, terminal stance (degrees)
Rethlefsen et al. [35]	1. Control 2. Orthosis; fixed AFO, articulated AFO	None	6	- The 3D gait analysis data: mean of ankle DF at initial and terminal stance (degrees)
Sutherland et al. [12]	1. Placebo 2. BoNT-A; injected into gastrocnemius for 4 U/Kg of hemiplegia, 4 U/Kg × 2 times for diplegia	None	8	- Number improvement of ankle DF at initial contact (degrees) - Number of improvements of VGA (graded 0–3 score, points) -Mean difference of PROM of ankle DF (degrees)
Ubhi et al. [11]	1. Placebo 2. BoNT-A; injected Dysport 15 U/Kg for hemiplegia, 25 U/Kg for diplegia at gastrocsoleus *3 cases were injected at hamstrings	Conventional PT with orthosis > 3 months before receive intervention	12	- Number of gait improvements of VGA (graded 0–4 score, points) - Number of improvement of GMFM dimension E (points)
Xu et al. [36]	1. PT 2. BoNT-A + PT - BoNT-A injected to ankle plantar flexors, 3 U/Kg for hemiplegia, 10 U/Kg for diplegia - PT in both groups; orthosis, NDT, stretching, strength and coordination training and task-specific training, and electrical stimulation (ES) 1–1.5 h/session, 5 days/week for 2 weeks	None	12	- Mean of PROM of ankle DF (degrees) - Mean score of GMFM dimension E (points)
Yigitoglu et al. [37]	1. BoNT- A 2. BoNT-A + electrical stimulation - ES applied to the gastrocnemius muscle for 20 min/1 time, for 10 days - BoNT-A10 U/Kg applied to the gastrocnemius and soleus muscles and home-based exercise programs for both groups	None	12	- Median of score of GMFM dimension E (points)

BoNT-A, Botulinum toxin A; PROM, passive range of motion; DF, dorsiflexion; AFO, ankle–foot orthosis; KAFO, knee–ankle–foot orthosis; PLS, posterior leaf spring; NDT, neurodevelopment therapy; ES, electrical stimulation; PT, physical therapy; OT, occupational therapy; PRS, Physician’s Rating Scale; VGA, Video Gait Analysis; OGS, Observational Gait Scale; CGAS, Clinical Gait Assessment Score, PROM, passive range of motion; AROM, active range of motion; and GMFM, the Gross Motor Function Measure