title: Treatment with botulinum toxin in children with cerebral palsy: a qualitative study of parents' experiences.
abstract: BACKGROUND
  In children with cerebral palsy everyday movements such as walking, standing and using one's hands can be difficult to perform because of spasticity. Botulinum neurotoxin type A (BoNT-A) are often used to reduce spasticity. The aim of this study was to describe how parents of children with cerebral palsy experienced the child's treatment with BoNT-A, how the child was affected by the treatment and how spasticity affected the child.
  
  
  METHODS
  A qualitative study in which 15 parents of children (6-13 years old) with cerebral palsy were interviewed about their experiences of the BoNT-A treatment. The children had received several BoNT-A treatments. An interview guide was used with topics: the child's functions before and after the treatment, the outcomes of the treatment and how they valued the BoNT-A treatment. Content analysis was used to analyse the interviews.
  
  
  RESULTS
  The analyses resulted in two themes: 'When softness comes and goes' and 'Both want and do not want'. The reduction of spasticity - softness - was described to promote motor functions, and facilitate the next step in motor development. The children were described as being more active out of their own initiative and having a happier mood. Spasticity, described as stiffness, was described to make walking more strenuous as well as interfering with activities. The BoNT-A injection procedure was perceived as troublesome and painful for the child, and sometimes traumatic for both children and parents.
  
  
  CONCLUSIONS
  Treatment with BoNT-A was described as facilitating motor development and activity. The children's and the parents' negative experiences of the injection procedure should be addressed.
authors.affiliation: Child and Youth Habilitation Centre, Region Örebro County, Örebro, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Lorin
authors.affiliation: Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Forsberg
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002547:Cerebral Palsy / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular / Q000009:adverse effects*; D007407:Interviews as Topic; D035002:Lower Extremity / Q000503:physiopathology; D008297:Male; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D010146:Pain / Q000209:etiology*; D010290:Parents / Q000523:psychology; D036301:Qualitative Research; D011788:Quality of Life; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology; D016138:Walking
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: botulinum toxin; cerebral palsy; experiences; parents; qualitative study; spasticity