title: Expert consensus on physical therapist intervention after botulinum toxin a injection for children with cerebral palsy.
abstract: OBJECTIVE
  The purpose of this study was to gather expert consensus on physical therapist (PT) intervention after lower extremity botulinum toxin A (BtA) injection(s) for children with cerebral palsy (CP) and lower extremity spasticity. This study also examined differences in expert opinion on intervention for two groups of children with CP and differing levels of functional ability.
  
  
  METHODS
  The Guide to Physical Therapist Practice was used to develop a questionnaire. Sixty-two therapists identified as experts in the field of pediatric physical therapy rated the importance of the three PT intervention components and the seven types of direct intervention from Neuromuscular Pattern 5A for both groups. The Wilcoxon signed rank test was used to identify differences in expert responses between the groups. Experts also ranked the importance of specific intervention strategies. Consensus criteria were used to determine the importance of interventions.
  
  
  RESULTS
  All three intervention components and four direct interventions (Therapeutic Exercise; Functional Training-Self-Care; Functional Training-Community and Work; and Prescription of Devices/Equipment) met consensus criteria for both groups. Significant differences between groups were found for Patient/Client-Related Instruction and Direct Interventions and for Therapeutic Exercise, Functional Training in Self-Care, Functional Training-Community and Work, and Electrotherapeutic Modalities, suggesting that these items were more important for children with greater functional abilities. Twenty (35%) specific intervention strategies met consensus criteria for one or both groups.
  
  
  CONCLUSIONS
  All three intervention components and four direct interventions in Neuromuscular Pattern 5A are important in the PT plan of care after botulinum toxin A injection for children with CP and lower extremity spasticity. Functional ability influences therapists' intervention choices.
authors.affiliation: The Research Center for Children with Special Health Care Needs and Physical Therapy Department, Franciscan Children’s Hospital and Rehabilitation Center (H.M.D., M.A.F.), Boston, Mass and Department of Rehabilitation Sciences, MCP Hahnemann University (M.E.O.), Philadelphia, Pa.
authors.forename: H M
authors.initials: HM
authors.lastname: Dumas
authors.forename: M E
authors.initials: ME
authors.lastname: O'neil
authors.forename: M A
authors.initials: MA
authors.lastname: Fragala