ICFInternational Classification of Function, Disability and Health ICF-CY International Classification of Function, Disability and Health -Children and Youth Version ROM Range of motion AIM The aim of this study was to determine the effects of repeat botulinum toxin A (BoNT-A)injections in children with spastic cerebral palsy (CP) on the basis of a best evidence synthesis.METHOD This study included 13 original articles after searching the literature to retrieve information. We used the critical review form produced by McMaster University to determine the methodological quality of the studies, and then confirmed the levels of evidence from Sackett. The studies were also evaluated using the International Classification of Function, Disability and Health -Children and Youth Version (ICF-CY).RESULTS A total of 893 children with spastic CP who had been administered repeat BoNT-A injections were evaluated. The evidence level was II in four of the thirteen studies, III in four studies, and IV in five studies. The McMaster review form score was 14 in two studies, 13 in four studies, and 12 in seven studies. The results showed that repeat BoNT-A may be a safe and an effective approach. The first two injections/one repeat especially relieve spasticity and improve fine and gross motor activities.INTERPRETATION Future studies to investigate the effectiveness of repeat BoNT-A in children with spastic CP may be planned within the framework of the ICF-CY to include well-designed randomized controlled trials and those conducted on larger homogenous groups.Cerebral palsy (CP) is a neuromuscular pathology that is caused by an injury to the immature brain, and that limits activity by affecting the development of body function and posture. 1,2 CP is the most common childhood disability, and about 70% to 80% is of the spastic type.

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Objective: The aim of this study was to determine motor repertoire at 3 to 5 months of age in infants with hypoxic-ischemic encephalopathy (HIE) and to examine changes according to HIE severity. Methods: Participants were 38 infants aged 3 to 5 months with HIE and 38 infants in the comparison group. The general movement assessment and the Motor Optimality Score (MOS) were used. Results: Infants in the HIE group had a significantly lower total MOS and scores for fidgety movements, age adequacy of motor repertoire, and quality of movement patterns compared with the comparison group. Infants with grade III HIE compared with grade I had a significantly lower MOS. Conclusions: Infants with HIE had poorer motor repertoire at age 3 to 5 months when compared with peers. Motor repertoire deteriorated as HIE severity increased. Detecting potential developmental delays as early as possible allows for early intervention and rehabilitation in this population.

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Purpose: This study aimed to investigate whether the movements and postures of 3-to 5-month-old infants with torticollis differ from those of infants without torticollis and to determine the relationship between clinical characteristics and the Motor Optimality Score (MOS) in torticollis. Methods: Participants were 40 infants with torticollis and 40 infants developing typically without torticollis. The infants were evaluated with detailed general movement assessment. Results: There were significant differences in the MOS and subcategory scores for age-adequate movement repertoire and observed postural patterns between groups. Clinical characteristics were not related to the reduction in the MOS. Conclusions: Infants with torticollis have differences in movements and postures at 3 to 5 months of age compared with controls. Strategies supporting the movement repertoire of infants with torticollis can be added to rehabilitation programs for infants with the lower MOS to optimize their motor development.