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Botulinum toxin A and upper limb functional skills in hemiparetic cerebral palsy: a randomized trial in children receiving intensive therapy
Author(s) -
Speth L A W M,
Leffers P,
JanssenPotten Y J M,
Vles J S H
Publication year - 2005
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/j.1469-8749.2005.tb01173.x
Subject(s) - cerebral palsy , medicine , physical therapy , context (archaeology) , upper limb , randomized controlled trial , randomization , range of motion , placebo , rehabilitation , wrist , botulinum toxin , physical medicine and rehabilitation , activities of daily living , muscle tone , hand strength , modified ashworth scale , grip strength , surgery , paleontology , alternative medicine , pathology , biology
The objective of this study was to determine whether the use of intramuscular botulinum toxin A (BTX‐A) increases upper limb function and skills in the context of a specific therapy programme in children with hemiparetic cerebral palsy. Twenty children (nine females, 11 males) aged 4 to 16 years who were thought likely to benefit from BTX‐A treatment were included. After matched pairs were made, on the basis of Zancolli grade and age, randomization took place. All patients were given structured rehabilitation (physiotherapy and occupational therapy three times a week for 6 months), and half of the patients received intramuscular BTX‐A. No placebo injections were given in the control group. Participants were assessed at baseline, at 2 and 6 weeks, and at 3, 6, and 9 months after injection. The Ash worth scale, active range of motion of arm joints, the Melbourne assessment of upper limb function, the Pediatric Evaluation of Disability Inventory, and the nine‐hole peg test were used for outcome measurement. Observers were blinded for treatment allocation only for scoring the Melbourne test. The children in the treatment group showed a clinically relevant increase in active dorsal flexion, and tone reduction of the wrist. For the functional outcome measures, no statistically significant differences between the groups could be demonstrated. Intramuscular BTX‐A added to an intensive therapy programme reduces impairment for at least 9 months; the effect on activity level is still uncertain.