Effects of botulinum toxin type A and a programme of functional activity to improve manual ability in children and adolescents with cerebral palsy

Abstract

We aimed to evaluate the effectiveness of a clinical programme that combined botulinum toxin injections with a functional activity programme to improve manual ability in children and adolescents with cerebral palsy. A total of 25 young people age range 2 to 19 years participated. They were given injections of botulinum toxin type A into spastic muscles in the upper extremities and participated in a functional activity training programme. Standardised clinical assessments were made before injections, one to two months after, and six months after, the final injections. To assess if the treatment had changed their ability to use the treated hand in activities of everyday life a questionnaire was given to the parents. The families thought that the ability had improved, and that the improvements took place both during the first three months after treatment and after more than six months after the final injections. The ability to extend wrist and fingers actively and the position of the thumb had improved significantly both in the short and long- term. This study supports the assumption that a programme combining botulinum toxin A injections with training in functional activity improves manual ability in young people with cerebral palsy.

Wearable wrist activity monitor as an indicator of functional hand use in children with cerebral palsy

“…To our knowledge, this is the first study to measure and demonstrate definitively the strong relationship between the frequency of wrist extensions and functional hand use in children with hemiplegia. Our findings support clinical acumen in addition to a number of studies suggesting the importance of maximizing wrist extension in rehabilitation strategies 23–25 . This study is well aligned with recent findings by Murgia et al., 26 who observed that the active range of movement of the wrist exhibited by adults who had suffered a distal radius fracture was smaller than that of adults with no hand impairments during a typical daily activity (i.e.…”

Botulinum toxin assessment, intervention and follow‐up for paediatric upper limb hypertonicity: international consensus statement

“…Commonly reported systemic events after UL BoNT include generalized fatigue [17,18] and ÔunwellnessÕ after injection [16,18]. Temporary localized weakness in grip strength or arm use was the most commonly reported local adverse event by the articles included in the evidence review [6,17,18,20]. Some studies found no adverse events [14], and others reported adverse events that were not thought to be Activity:…”

Treatment with botulinum toxin in children with cerebral palsy: a qualitative study of parents' experiences

“…Studies show that functional activity programmes, physiotherapy or occupational therapy, after the injection of BoNT‐A, can improve functional activity of the upper limb (Rosblad et al . ; Ferrari et al . ; Lin et al .…”

“…A recent review presents that a multimodal approach is required, in which treatment with BoNT-A is followed by physiotherapy, occupational therapy or orthoses (Strobl et al 2015). Studies show that functional activity programmes, physiotherapy or occupational therapy, after the injection of BoNT-A, can improve functional activity of the upper limb (Rosblad et al 2007;Ferrari et al 2014;Lin et al 2015).The effect of BoNT-A is reversible; therefore, treatment often needs to be repeated. Local side effects are frequent after BoNT-A injection, pain, swelling and bruising; however, serious side effects are reported in 1%-2% of cases (Hoare et al 2010).…”