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Botulinum toxin A injections and occupational therapy in children with unilateral spastic cerebral palsy: a
Git Lidman1,2, Ann Nachemson3, Marie Peny-Dahlstrand1,2
1Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Repeated botulinum toxin A injections combined with occupational therapy improved hand function in children with unilateral spastic cerebral palsy more than therapy alone. Both groups showed improvements in active range of motion and goal achievement.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Occupational Therapy
Background:
- Unilateral spastic cerebral palsy (USCP) significantly impacts hand function in children.
- Effective interventions are crucial for improving bimanual performance and overall function.
Purpose of the Study:
- To compare the efficacy of repeated botulinum toxin A (BoNT-A) injections plus occupational therapy (OT) versus OT alone for children with USCP.
- To evaluate effects across all International Classification of Functioning, Disability and Health (ICF) domains.
Main Methods:
- A randomized, population-based, evaluator-blinded controlled study.
- Twenty children with USCP received either OT alone or BoNT-A/OT over one year.
- Primary outcome: Assisting Hand Assessment (AHA); Secondary outcomes: Range of Movement (ROM), Canadian Occupational Performance Measure.
Main Results:
- The BoNT-A/OT group showed superior improvement in AHA at 12 months (6/10 improved vs. 1/10 in OT alone group, p<0.03).
- Significant improvement in bimanual hand function was observed in the BoNT-A/OT group.
- Secondary outcomes, including active ROM and goal performance, improved in both treatment groups.
Conclusions:
- Repeated BoNT-A injections combined with occupational therapy demonstrate superior outcomes for bimanual hand function in young children with USCP compared to OT alone.
- This combined approach offers a promising strategy for enhancing functional abilities in children with USCP.
Aim:
To investigate the effects of repeated botulinum toxin A (BoNT-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 BoNT-A plus occupational therapy (BoNT-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 BoNT-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 BoNT-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.
