Botulinum toxin A and upper limb functional skills in hemiparetic cerebral palsy: a randomized trial in children receiving intensive therapy
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Published on: October 11, 2024
L A W M Speth1, P Leffers, Y J M Janssen-Potten
1Rehabilitation Foundation Limburg (SRL), location Franciscusoord, Valkenburg, the Netherlands. l.speth@srl.nl
Insights
Intramuscular botulinum toxin A (BTX-A) combined with therapy improved wrist function in children with hemiparetic cerebral palsy. However, significant improvements in overall upper limb activity were not observed, suggesting further research is needed.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Hemiparetic cerebral palsy (CP) significantly impacts upper limb function in children.
- Botulinum toxin A (BTX-A) is used to manage spasticity in CP, but its effect on function requires further investigation.
- Intensive therapy programs are crucial for managing CP-related impairments.
Purpose of the Study:
- To evaluate the efficacy of intramuscular botulinum toxin A (BTX-A) in enhancing upper limb function and skills in children with hemiparetic cerebral palsy.
- To assess the impact of BTX-A when administered as part of a structured therapy program.
- To determine if BTX-A treatment leads to clinically relevant improvements in motor function and activity levels.
Main Methods:
- A randomized study involving 20 children (aged 4-16 years) with hemiparetic CP, divided into a BTX-A treatment group and a control group.
- Both groups received a 6-month structured rehabilitation program (physiotherapy and occupational therapy).
- Outcome measures included the Ashworth scale, active range of motion, Melbourne upper limb assessment, Pediatric Evaluation of Disability Inventory, and nine-hole peg test, assessed over 9 months.
Main Results:
- The BTX-A group demonstrated a clinically significant increase in active wrist dorsal flexion and reduced wrist tone.
- No statistically significant differences were found between the groups for the functional outcome measures.
- Impairment reduction was observed for at least 9 months in the BTX-A group, but effects on activity level remained uncertain.
Conclusions:
- Intramuscular BTX-A, when added to an intensive therapy program, effectively reduces upper limb impairment in children with hemiparetic CP for up to 9 months.
- The impact of BTX-A on the activity level of affected children requires further investigation.
- BTX-A shows potential as an adjunct therapy for managing spasticity and improving specific motor impairments in pediatric hemiparetic CP.
Abstract:
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 Ashworth 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.
