Inclusion criteria | Exclusion criteria |
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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 |