title: Botulinum toxin type-A and plaster cast treatment in children with upper brachial plexus palsy.
abstract: OBJECTIVE
  Electrical stimulation, physical therapy and occupational therapy remain the main treatment for children with upper brachial plexus palsy (UBPP), when surgery has been excluded. A pilot study was undertaken to investigate whether botulinum toxin type A (BoNT-A) and plaster casting, as adjunct to the physical therapy, decreased muscle contracture and improved the position and function of the impaired arm.
  
  
  METHODS
  Twenty-two children (mean age 5.6 +/- 3.4 years) with mild UBPP who previously underwent serial cast treatment, unsuccessfully, were enrolled. Neurological impairment and functional status were quantified using Medical Research Council (MRC) and Mallet scales and the Nine-Hole Peg Test (NHPT). Elbow extension was measured using a goniometer. Biceps brachii, brachialis, pronator teres and pectoralis major muscles were injected with 22 units kg(-1) BoNT-A (Dysport, Ipsen). After injection, the treated arm was fixed with a plaster cast and progressively lengthened over 14 days. The cast was maintained for 30 days. Assessments of elbow extension, MRC, Mallet Scale and NHPT were made at baseline, 3, 6 and 12 months.
  
  
  RESULTS
  After BoNT-A injection, children had significant improvement of active elbow extension (15.5 degrees +/- 17.1 at 12 months after injection, compared with 42.0 degrees +/- 10.4 at baseline; p < 0.001). NPHT scores improved significantly over the 12 months (51.1 +/- 21.8 seconds compared with 56.7 +/- 19.3 seconds at baseline, p < 0.01). MRC and Mallet scale scores of the paretic muscles were unchanged.
  
  
  CONCLUSIONS
  The children showed a reduction in muscular contracture and improvements of the arm position and elbow extension. The data support the use of BoNT-A and plaster casting as an adjunct to physical therapy, in the treatment of children with mild UBPP.
authors.affiliation: Department of Rehabilitation, IRCCS, Casa Sollievo della Sofferenza, S. Giovanni Rotondo, FG, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Basciani
authors.forename: D
authors.initials: D
authors.lastname: Intiso
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D020516:Brachial Plexus Neuropathies / Q000503:physiopathology / Q000628:therapy*; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003286:Contracture / Q000628:therapy*; D004185:Disability Evaluation; D004551:Elbow Joint / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010865:Pilot Projects; D016059:Range of Motion, Articular
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A