Archives of Physical Medicine and Rehabilitation
Volume 88, Issue 1 , Pages 1-10 , January 2007

Functional Outcomes of Intramuscular Botulinum Toxin Type A and Occupational Therapy in the Upper Limbs of Children With Cerebral Palsy: A Randomized Controlled Trial

Presented in part to the OT Australia 22nd National Conference, April 6–9, 2003, Melbourne, Australia, and the Australasian Academy of Cerebral Palsy and Developmental Medicine, March 19–20, 2004, Melbourne, Australia.

  • Margaret Wallen, MA, BAppScOT

      Affiliations

    • Department of Occupational Therapy, The Children’s Hospital at Westmead, Sydney, Australia
    • Corresponding Author InformationCorrespondence to Margaret Wallen, MA, BAppScOT, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia
  • ,
  • Stephen J. O’Flaherty, FAFRM, FRACP, MB ChB

      Affiliations

    • Department of Rehabilitation, The Children’s Hospital at Westmead, Sydney, Australia.
  • ,
  • Mary-Clare A. Waugh, FAFRM, FRACP, MBBS

      Affiliations

    • Department of Rehabilitation, The Children’s Hospital at Westmead, Sydney, Australia.

References 

  1. Jefferson RJ. Botulinum toxin in the management of cerebral palsy. Dev Med Child Neurol. 2004;46:491–499
  2. National Institutes of Health Consensus Development. Clinical use of botulinum toxin. Arch Neurol. 1991;48:1294–1298
  3. Hoare B, Imms C. Upper-limb injections of botulinum toxin-A in children with cerebral palsy: a critical review of the literature and clinical implications for occupational therapists. Am J Occup Ther. 2004;58:389–397
  4. Wasiak J, Hoare B, Wallen M. Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy. Cochrane Database Syst Rev. 2004;(4):CD003469
  5. Jankovic J, Esquenazi A, Fehlings D, Freitag F, Lang AM, Naumann M. Evidence-based review of patient-reported outcomes with botulinum toxin type A. Clin Neuropharmacol. 2004;27:234–244
  6. Steenbeek D, Meester-Delver A, Becher JG, Lankhorst GJ. The effect of botulinum toxin type A treatment of the lower extremity on the level of functional abilities in children with cerebral palsy: evaluation with goal attainment scaling. Clin Rehabil. 2005;19:274–282
  7. Graham HK. Botulinum toxin A in cerebral palsy: functional outcomes. J Pediatr. 2000;137:300–303
  8. Lannin N, Clark K, Scheinberg A. New South Wales therapy practices for children with cerebral palsy who have received botulinum toxin-A. Aust Occup Ther J. 2004;51:208–212
  9. Lannin N, Scheinberg A, Clark K. AACPDM systematic review of the effectiveness of therapy for children with cerebral palsy after botulinum toxin A injections. Dev Med Child Neurol. 2006;48:533–539
  10. Fehlings DL, Rang M, Glazier J, Steele C. An evaluation of botulinum-A toxin injections to improve upper extremity function in children with hemiplegic cerebral palsy. J Pediatr. 2000;137:331–337
  11. Lowe K, Novak I, Cusick A. Low-dose/high-concentration localized botulinum toxin A improves upper limb movement and function in children with hemiplegic cerebral palsy. Dev Med Child Neurol. 2006;48:170–175
  12. Speth LA, Leffers P, Janssen-Potten YJ, Vles JS. Botulinum toxin A and upper limb functional skills in hemiparetic cerebral palsy: a randomized trial in children receiving intensive therapy. Dev Med Child Neurol. 2005;47:468–473
  13. World Health Organization. International classification of functioning, disability and health. Geneva: WHO; 2001;
  14. Darzins P, Fone S, Darzins S. The international classification of functioning, disability and health can help to structure and evaluate therapy. Aust Occup Ther J. 2006;53:127–131
  15. Wong V, Ng A, Sit P. Open-label study of botulinum toxin for upper limb spasticity in cerebral palsy. J Child Neurol. 2002;17:138–142
  16. Hurvitz EA, Conti GE, Brown S. Changes in movement characteristics of the spastic upper extremity after botulinum toxin injection. Arch Phys Med Rehabil. 2003;84:444–454
  17. Yang TF, Fu CP, Kao NT, Chan RC, Chen SJ. Effect of botulinum toxin type A on cerebral palsy with upper limb spasticity. Am J Phys Med Rehabil. 2003;82:284–289
  18. Corry IS, Cosgrove AP, Walsh EG, McClean D, Graham HK. Botulinum toxin A in the hemiplegic upper limb: a double-blind trial. Dev Med Child Neurol. 1997;39:185–193
  19. Law M, Baptiste S, Carswell A, McColl MA, Polatajko H, Pollock N. Canadian Occupational Performance Measure. 2nd ed.. Toronto: Canadian Association of Occupational Therapists; 1998;
  20. Kiresuk TJ, Smith A, Cardillo JE. Goal attainment scaling: applications, theory, and measurement. Hillsdale: Lawrence Erlbaum Associates; 1994;
  21. Wallen M, O’Flaherty SJ, Waugh MC. Functional outcomes of intra-muscular botulinum toxin A in the upper limbs of children with cerebral palsy: a phase II trial. Arch Phys Med Rehabil. 2004;85:192–200
  22. King GA, McDougall J, Palisano RJ, Gritzan J, Tucker MA. Goal Attainment Scaling: its use in evaluating pediatric therapy programs. Phys Occup Ther Pediatr. 1999;19:31–52
  23. Randall MJ, Johnson LM, Reddihough DS. The Melbourne Assessment of Unilateral Upper Limb Function. Melbourne: Royal Children’s Hospital, Melbourne; 1999;
  24. Waters E, Salmon L, Wake M, Wright M, Hesketh K. Australian Authorised Adaptation of the Child Health Questionnaire. Melbourne: Centre for Community Child Health, Royal Children’s Hospital Melbourne; 1999;
  25. DeMatteo C, Law M, Russell D, Pollock N, Rosenbaum P, Walter S. QUEST: Quality of Upper Extremity Skills Test. Hamilton: McMaster Univ, Neurodevelopmental Clinical Research Unit; 1992;
  26. DeMatteo C, Law M, Russell D, Pollock N, Rosenbaum P, Walter S. The reliability and validity of Quality of Upper Extremity Skills Test. Phys Occup Ther Pediatr. 1993;13(2):1–18
  27. Haley SM, Coster WJ, Ludlow LH, Haltiwanger JT, Andrellos PJ. Pediatric Evaluation of Disability Inventory (PEDI). Boston: New England Medical Center Hospitals; 1992;
  28. Reid DT, Boschen KA, Wright FG. Critique of the Pediatric Evaluation of Disability Inventory (PEDI). Phys Occup Ther Pediatr. 1993;13(4):57–87
  29. Wright FG, Boschen KA. Responsiveness to change of the Pediatric Evaluation of Disability Inventory when used with children with cerebral palsy. Dev Med Child Neurol. 1995;37(Suppl 73):14–15
  30. Tardieu G, Shentoub S, Delarue R. A la recherche d’une technique de mesure de la spasticite imprime avec le periodique. Neurologique. 1954;91:143–144
  31. Blair E, Love S, Valentine J. Proportional change: an additional method of reporting technical and functional outcomes following clinical interventions. Eur J Neurol. 2001;8(Suppl 5):178–182
  32. Mackey AH, Walt SE, Lobb G, Stott NS. Intraobserver reliability of the modified Tardieu scale in the upper limb of children with hemiplegia. Dev Med Child Neurol. 2004;46:267–272
  33. Smith A, Cardillo JE, Casey-Smith S, Amezaga AM. Improvement scaling (rehabilitation version) (A new approach to measuring progress of patients in achieving their individual rehabilitation goals). Med Care. 1998;36:333–347
  34. Arner M, Beckung E, Eliasson A, Krumlinde-Sundholm L, Rosenbaum P, Rosblad B. MACS: Manual Ability Classification System for children with cerebral palsy 4–18 years. Available at: http://www.macs.nu. Accessed October 9, 2006.
  35. Krumlinde-Sundholm L, Holmefur M, Eliasson A. Manual: Assisting Hand Assessment. English research version 4.3. Stockholm: Karolinska Institute; 2006;

 Supported by The Children’s Hospital Fund of The Children’s Hospital at Westmead and Allergan Australia.No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.Reprints are not available from the author.

PII: S0003-9993(06)01425-0

doi: 10.1016/j.apmr.2006.10.017

Archives of Physical Medicine and Rehabilitation
Volume 88, Issue 1 , Pages 1-10 , January 2007