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Long‐term effects of repeated botulinum neurotoxin A, bimanual training, and splinting in young children with cerebral palsy
Author(s) -
Lidman Git R M,
Nachemson Ann K,
PenyDahlstrand Marie B,
Himmelmann Kate M E
Publication year - 2020
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.14298
Subject(s) - occupational therapy , medicine , cerebral palsy , physical therapy , rehabilitation , spastic , randomized controlled trial , repeated measures design , physical medicine and rehabilitation , pediatrics , surgery , statistics , mathematics
Aim To investigate long‐term development of hand function after repeated botulinum neurotoxin A (BoNT‐A) and occupational therapy at a young age. Method Twenty children with unilateral spastic cerebral palsy (CP) (14 males, six females; median inclusion age 3y 1mo, range 1y 11mo–4y 3mo) participated in this longitudinal study. Ten children received occupational therapy after a randomized controlled trial and 10 repeated BoNT‐A plus occupational therapy during 1‐year. The Assisting Hand Assessment (AHA) and active supination, assessed the following 3 years. The assessments were compared with data from a reference group to investigate development over time. Results The improvement in AHA (7.5 AHA units) after BoNT‐A plus occupational therapy was maintained at final follow‐up. The occupational therapy group, unchanged after 1‐year, improved by 5 AHA units (96% confidence interval [CI] 2–10), thus there was no difference between the groups. Median active supination increased in comparison with the reference group. In the BoNT‐A/occupational therapy group, 9 out of 10 (97.85% CI 45 115) children improved in active supination. In the occupational therapy group, 7 out of 10 (97.85% CI –2 to 68) children improved in active supination. No correlation between active supination and AHA was found. Interpretation Bimanual performance achieved after BoNT‐A plus occupational therapy was maintained, while it increased by follow‐up in the occupational therapy group, suggesting that combined intervention gave earlier access to bimanual skills. Active supination was unrelated to AHA. What this paper adds Children whose bimanual performance improved after botulinum neurotoxin A and/or occupational therapy, maintained skills or progressed during follow‐up. Bimanual performance increased with age, similar to a quality‐register reference group. Increased active supination after intervention improved at follow‐up but was not related to bimanual performance.