Botulinum toxin-a in children with congenital spastic hemiplegia does not improve upper extremity motor-related function over rehabilitation alone: a randomized controlled trial.
BACKGROUND
Rehabilitation of the upper extremity in children with hemiplegic cerebral palsy has not been compared to the same intensity of therapy combined with injected botulinum toxin (BTX).


OBJECTIVE
To measure the short-term (2 weeks) and long-term (6 and 9 months) effects of a standardized functional training program versus without the addition of chemodenervation of forearm and hand muscles.


METHODS
Twenty children with spastic hemiplegia, aged 4 to 16 years, were matched for baseline characteristics and then randomized to standardized functional physical and occupational therapies for 6 months (PT/OT group) or to the same therapies plus multimuscle BTX-A (BTX+ group).


METHODS
were isometric generated force, overshoot and undershoot (force production error), active and passive range of motion by goniometry (ROM), stretch restricted angle (SRA) of joints, Ashworth scores at the elbow and wrist, and the Melbourne assessment of unilateral upper limb function. All measures were performed at baseline, 2 weeks after BTX-A, 6 months (end of therapy), and then 3 months after termination of the therapy.


RESULTS
Clinical measures (muscle tone, active ROM of wrist and elbow) showed improvement in both groups. However, no significant differences emerged between groups on functional measures. Generated force decreased directly after the BTX-A injection but increased during the therapy period. The PT/OT group, however, showed a significantly higher increase in force and accuracy with therapy compared with the BTX+ therapy group.


CONCLUSIONS
Functional rehabilitation therapies for the upper extremity increase manual isometric flexor force at the wrist and ROM, but BTX injections cause weakness and do not lead to better outcomes than therapy alone.
Rameckers
E A A
EA
Avans+, University for Professionals, Breda The Netherlands. eaa.rameckers@hetnet.nl
Speth
L A W M
LA
Duysens
J
J
Vles
J S H
JS
Smits-Engelsman
B C M
BC
D000293:Adolescent; D001132:Arm / Q000294:innervation / Q000503:physiopathology*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000534:rehabilitation; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D005260:Female; D006429:Hemiplegia / Q000151:congenital / Q000188:drug therapy* / Q000534:rehabilitation; D006801:Humans; D008297:Male; D009068:Movement / Q000502:physiology; D053580:Muscle Strength / Q000502:physiology; D009129:Muscle Tonus / Q000502:physiology; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000009:adverse effects; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D016059:Range of Motion, Articular / Q000502:physiology; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A