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Botulinum toxin A injections and occupational therapy in children with unilateral spastic cerebral palsy: a randomized controlled trial
Author(s) -
Lidman Git,
Nachemson Ann,
PenyDahlstrand Marie,
Himmelmann Kate
Publication year - 2015
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.12739
Subject(s) - occupational therapy , medicine , cerebral palsy , randomized controlled trial , physical therapy , confidence interval , spastic , rehabilitation , population , pediatrics , surgery , environmental health
Aim To investigate the effects of repeated botulinum toxin A (Bo NT ‐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. Method 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 Bo NT ‐A plus occupational therapy (Bo NT ‐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 Bo NT ‐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. Interpretation Repeated Bo NT ‐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.