title: Effects of botulinum toxin A and/or bimanual task-oriented therapy on upper extremity impairments in unilateral Cerebral Palsy: an explorative study.
abstract: OBJECTIVE
  This study reports on the effects of botulinum toxin A (BoNT-A) injections in the upper extremity (UE) of children with unilateral Cerebral Palsy (uCP) combined with bimanual task oriented therapy (BITT) or either treatment modality performed separately on UE range of motion (ROM), spasticity and (functional) strength.
  
  
  METHODS
  Thirty-five children, mean age 7.14 years (SD 2.63) of whom 11 had a Manual Ability Classification Score (MACS) I, 15 MACS II and 9 MACS III, participated. The trial started with four study groups: BoNT-A-only (n = 5), BITT-only (n = 11), BoNT-A + BITT (n = 13), and control (n = 6). Twenty-two children were randomized and, due to recruitment problems 13 children received their parents' preferred treatment: BoNT-A + BITT or BITT-only. Three comparisons were analysed: BITT (BoNT-A + BITT and BITT-only; n = 24) versus no BITT (BoNT-A-only and control; n = 11), BoNT-A (BoNT-A-only and BoNT-A + BITT; n = 18) versus no BoNT-A (BITT-only and control; n = 17), and the additional effect of BoNT-A (BoNT-A + BITT versus BITT-only).
  
  
  RESULTS
  BoNT-A significantly decreased key grip strength and finger flexion tone, had a clinically relevant (additional) positive effect on active thumb abduction and supination and a significantly negative effect on unilateral functional strength. BITT + BoNT-A significantly increased active supination. BITT reduced elbow flexor tone and BITT-only resulted in more improvement than BoNT-A + BITT in functional unimanual and, to a lesser extent, in bimanual grip strength.
  
  
  CONCLUSIONS
  In comparison with BoNT-A + BITT, BITT-only gives more improvement on functional grip strength and, therefore, could possibly increase bimanual performance. In this case, the (additional) role of BoNT-A may be an increase in active supination and thumb abduction.
authors: Adelante, Paediatric Rehabilitation Centre, Onderstestraat 29, 6301 KA Valkenburg, The Netherlands; Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands. Electronic address: l.speth@adelante-zorggroep.nl.
authors: Lucianne
authors: L
authors: Speth
authors: Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands; Maastricht University, Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht, The Netherlands.
authors: Yvonne
authors: Y
authors: Janssen-Potten
authors: Maastricht University, Department of Epidemiology, Maastricht, The Netherlands.
authors: Pieter
authors: P
authors: Leffers
authors: Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands; Maastricht University, Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht, The Netherlands.
authors: Eugene
authors: E
authors: Rameckers
authors: Adelante, Paediatric Rehabilitation Centre, Onderstestraat 29, 6301 KA Valkenburg, The Netherlands.
authors: Anke
authors: A
authors: Defesche
authors: Maastricht University, Department of Methodology and Statistics, Maastricht, The Netherlands.
authors: Bjorn
authors: B
authors: Winkens
authors: Free University Medical Centre, Department of Rehabilitation Medicine, Amsterdam, The Netherlands.
authors: Jules
authors: J
authors: Becher
authors: Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands; Maastricht University, Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht, The Netherlands; Maastricht University Medical Centre, Department of Rehabilitation Medicine, Maastricht, The Netherlands.
authors: Rob
authors: R
authors: Smeets
authors: Maastricht University Medical Centre, Department of Neurology, Maastricht, The Netherlands; Maastricht University, Research School GROW, Department of Neurology, Maastricht, The Netherlands.
authors: J S H
authors: JS
authors: Vles
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000534:rehabilitation*; D002648:Child; D003131:Combined Modality Therapy / Q000379:methods; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000188:drug therapy; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D016059:Range of Motion, Articular / Q000187:drug effects; D034941:Upper Extremity / Q000503:physiopathology
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Bimanual; Botulinum toxin A; Cerebral Palsy; Functional therapy; Strength; Upper extremity