Effects of Botulinum Toxin A And/or Bimanual Task-oriented Therapy on Upper Extremity Activities in Unilateral Cerebral Palsy: a Clinical Trial

Overview

Journal BMC Neurol

Publisher Biomed Central

Specialty Neurology

Date 2015 Aug 20

PMID 26286662

Citations 5

Authors

Lucianne Speth

Yvonne Janssen-Potten

Eugene Rameckers

Anke Defesche

Bjorn Winkens

Jules Becher

Rob Smeets

Hans Vles

Affiliations

Soon will be listed here.

Abstract

Background: This study reports on the effects of botulinum toxin A (BoNT-A) injections in the upper extremity (UE) in children with unilateral Cerebral Palsy (uCP) combined with bimanual task-oriented therapy (BITT) or either treatment modality performed separately. Bimanual activities were measured with the Assisting Hand Assessment (AHA), the ABILHand-Kids questionnaire (AK), the Observational Skills Assessment Score (OSAS). Goal achievement was measured with Goal Attainment Scaling (GAS), using blind video assessment, and the Canadian Occupational Performance Measure (COPM).

Methods: Thirty-five children, mean age 7.14 years (SD 2.63), 11 Manual Ability Classification Score (MACS) I, 15 MACS II and 9 MACS III, participated. The trial started with four study groups: BoNT-A-only (n = 5), BITT-only (n = 11), BoNT-A + BITT (n = 13), and control (n = 6). Twenty-two children were randomised, 13 children received their parents' preferred treatment: BoNT-A + BITT or BITT-only. Three comparisons were analysed: BITT (BoNT-A + BITT and BITT-only; n = 24) versus no BITT (BoNT-A-only and control; n = 11), BoNT-A (BoNT-A-only and BoNT-A + BITT; n = 18) versus no BoNT-A (BITT-only and control; n = 17), and the additional effect of BoNT-A (BoNT-A + BITT versus BITT-only). Follow-up time: 24 weeks.

Results: No significant differences between the groups were found on the AHA. The amount of use of both hands on the OSAS was significantly better in the BoNT-A group in the beading and sandwich-making task. The BoNT-A group also showed significant improvement in the quality scores of the OSAS: the wrist position during grasping and holding, especially in the younger children. The BITT group improved significantly on the AK and significantly more on the performance and satisfaction scores of the COPM at 12 and 24 weeks regarding several goals. BoNT-A showed a significant negative effect at 12 and 24 weeks in the most important goal. BITT, more than BoNT-A + BITT, showed positive effects on the GAS score at 12 (significant), 18 and 24 weeks.

Conclusions: BoNT-A has a positive effect on quality of movement and amount of use of the affected UE during the 3 months' working time. BoNT-A has no additional effect on bimanual performance and goal achievement. BITT has a positive effect on goal achievement and bimanual performance, even up to 6 weeks after therapy had stopped.

Trial Registration: Current Controlled Trials ISRCTN69541857.

Citing Articles

Limited Evidence of Functional Benefit After Upper Limb Botulinum Toxin Treatment in Children With Cerebral Palsy: Systematic Review and Meta-analysis.

Gresits O, Vezer M, Engh M, Szabo L, Molnar Z, Hegyi P Am J Phys Med Rehabil. 2025; 104(2):108-116.

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Physical Exercises in Combination with Botulinum Toxin in Treating Children with Cerebral Palsy: A Literature Review.

Sharma A, Vats S, Chahal A J Lifestyle Med. 2023; 12(3):138-147.

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A patient- and parent-centered approach to urinary and fecal incontinence in children and adolescents with spina bifida: understanding experiences in the context of other competing care issues.

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Botulinum Toxin A Injection in Treatment of Upper Limb Spasticity in Children with Cerebral Palsy: A Systematic Review of Randomized Controlled Trials.

Farag S, Mohammed M, El-Sobky T, ElKadery N, ElZohiery A JBJS Rev. 2020; 8(3):e0119.

PMID: 32224633 PMC: 7161716. DOI: 10.2106/JBJS.RVW.19.00119.

Barriers to recruitment of children with cerebral palsy in a trial of home-based training.

Beckers L, Rameckers E, Smeets R, van der Burg J, Aarts P, Schnackers M Contemp Clin Trials Commun. 2019; 15:100371.

PMID: 31198879 PMC: 6556814. DOI: 10.1016/j.conctc.2019.100371.

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