title: Botulinum toxin A injections and occupational therapy in children with unilateral spastic cerebral palsy: a randomized controlled trial.
abstract: OBJECTIVE
  To investigate the effects of repeated botulinum toxin A (BoNT-A) injections combined with occupational therapy, including a splint, compared with occupational therapy alone on hand function in children with unilateral spastic cerebral palsy (USCP), in all International Classification of Functioning, Disability and Health (ICF) domains.
  
  
  METHODS
  This was a randomized controlled study, population-based and evaluator-blinded for primary outcome (October 2004 to September 2010). Twenty children (14 males; median age 3y 1mo) with USCP, recruited at a rehabilitation centre in Sweden, were assigned to one of two parallel groups using concealed allocation. In the course of one year, 10 children received occupational therapy, while 10 received repeated BoNT-A plus occupational therapy (BoNT-A/OT). Primary outcome (Assisting Hand Assessment [AHA]), and secondary outcome measures (range of movement [ROM], and Canadian Occupational Performance Measure), were measured at baseline, 3, 6, 9, and 12 months.
  
  
  RESULTS
  AHA revealed a superior effect in the BoNT-A/OT group at 12 months: 6 out of 10 improved compared with 1 out of 10 in the occupational therapy group (p<0.03). A 95% Peskun exact confidence interval for the difference in proportions is given as 0.01 to 0.81. Secondary outcomes improved in both groups.
  
  
  CONCLUSIONS
  Repeated BoNT-A/OT appeared superior to occupational therapy alone for bimanual performance in young children with USCP. Active ROM and goal performance improved in both groups.
authors: Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|Regional Rehabilitation Center, Queen Silvia's Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Git
authors: G
authors: Lidman
authors: Department of Hand and Plastic Surgery/Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Ann
authors: A
authors: Nachemson
authors: Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|Regional Rehabilitation Center, Queen Silvia's Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Marie
authors: M
authors: Peny-Dahlstrand
authors: Regional Rehabilitation Center, Queen Silvia's Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.|Department of Paediatrics, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors: Kate
authors: K
authors: Himmelmann
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000494:pharmacology*; D002547:Cerebral Palsy / Q000188:drug therapy / Q000628:therapy*; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006225:Hand / Q000503:physiopathology*; D006801:Humans; D007267:Injections; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000494:pharmacology*; D009788:Occupational Therapy / Q000379:methods*; D017063:Outcome Assessment, Health Care; D016037:Single-Blind Method
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A