Functional outcomes of intramuscular botulinum toxin type a and occupational therapy in the upper limbs of children with cerebral palsy: a randomized controlled trial.
OBJECTIVE
To investigate the functional outcomes of botulinum toxin type A (BTX-A) injections to the upper limb in combination with occupational therapy (OT) in children with cerebral palsy (CP).


METHODS
Randomized controlled trial with follow-up at 2 weeks, 3 months, and 6 months.


METHODS
Specialist outpatient physical disabilities clinic within a public pediatric teaching hospital.


METHODS
Eighty children with spastic quadriplegic, triplegic, or hemiplegic CP from these clinics were randomly assigned to BTX-A plus OT, BTX-A alone, OT alone, or a no-treatment control group.


METHODS
Single set of BTX-A (Botox) injections and 12 weeks of OT.


METHODS
Canadian Occupational Performance Measure (COPM) and Goal Attainment Scale (GAS).


RESULTS
The combination of BTX-A and OT resulted in accelerated attainment of functional goals measured by the COPM and GAS. There were no differences between groups on the Melbourne Assessment of Unilateral Upper Limb Function, Quality of Upper Extremity Skills Test, Pediatric Evaluation of Disability Inventory, Child Health Questionnaire, or active and passive range of motion. As expected, there was a significant reduction in muscle tone at follow-up 2 weeks after injection, which returned to baseline level by 6 months.


CONCLUSIONS
OT enhanced individualized functional outcomes following BTX-A injections in the upper limbs of children with CP.
Wallen
Margaret
M
Department of Occupational Therapy, The Children's Hospital at Westmead, Sydney, Australia. margarew@chw.edu.au
O'Flaherty
Stephen J
SJ
Waugh
Mary-Clare A
MC
D000203:Activities of Daily Living; D000293:Adolescent; D000704:Analysis of Variance; D001132:Arm / Q000503:physiopathology; D001294:Attitude to Health; D019274:Botulinum Toxins, Type A / Q000494:pharmacology / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D009465:Neuromuscular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D009788:Occupational Therapy / Q000379:methods*; D010290:Parents / Q000523:psychology; D011597:Psychomotor Performance / Q000187:drug effects; D016059:Range of Motion, Articular / Q000187:drug effects; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A