Evaluating Functional Outcomes of Botulinum Toxin Type A Injection Combined with Occupational Therapy in the Upper Limbs of Children with Cerebral Palsy: A 9-Month Follow-Up from the Perspectives of Both Child and Caregiver

PLoS One. 2015 Nov 24;10(11):e0142769. doi: 10.1371/journal.pone.0142769. eCollection 2015.

Abstract

Objective: To assess the effectiveness of combining botulinum toxin type A (BoNT-A) with functional occupational therapy (OT) at 9-month follow-up in children with cerebral palsy (CP) with bilateral upper limb impairments from the perspectives of both child and caregiver.

Methods: Twelve children with CP and their caregivers were assessed across 5 time points over 9 months based on the ICF after BoNT-A injection and functional OT in this open-label study.

Results: Significant differences were found across the 5 time points (p < .05) for both grasp and visual-motor integration with small effects (effect sizes = 0.12-0.24) and the self-care capability and performance of social function (p < .05). However, based on the effect sizes (0.02-0.14), no significant effects were found at the 4 post-test time points. Small effects were found on the psychological domain (effect sizes = 0.25-0.37) and environmental domains (effect size = 0.27) at follow-ups.

Conclusion: Combining a BoNT-A injection with OT not only reduced the muscle tone and increased ROM but also improved the upper limb function and self-care capability in children with CP. More importantly, these effects persisted for up to 9 months. Functional OT extends the effectiveness of a BoNT-A injection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Botulinum Toxins, Type A / administration & dosage*
  • Caregivers
  • Cerebral Palsy / drug therapy*
  • Cerebral Palsy / epidemiology*
  • Cerebral Palsy / pathology
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Humans
  • Injections, Intramuscular
  • Male
  • Muscle Spasticity / drug therapy*
  • Muscle Spasticity / epidemiology*
  • Muscle Spasticity / pathology
  • Occupational Therapy
  • Treatment Outcome
  • Upper Extremity / pathology

Substances

  • Botulinum Toxins, Type A

Grants and funding

This research was supported by the funding from the National Science Council, Taiwan. [NSC 101-2314-B-006-003] and the National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan [NCKUH-10407018]. This research was, in part, supported by the Ministry of Education, Taiwan, R.O.C. The Aim for the Top University Project to the National Cheng Kung University (NCKU). This research received funding from the Headquarters of University Advancement at the National Cheng Kung University, which is sponsored by the Ministry of Education, Taiwan, ROC.