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Long-term effects of repeated botulinum neurotoxin A, bimanual training, and splinting in young children with cerebral palsy

Journal article
Authors Git Lidman
A. K. Nachemson
Marie Peny-Dahlstrand
Kate Himmelmann
Published in Developmental Medicine and Child Neurology
Volume 62
Issue 2
Pages 252-258
ISSN 0012-1622
Publication year 2020
Published at Institute of Neuroscience and Physiology
Institute of Clinical Sciences, Department of Pediatrics
Pages 252-258
Language en
Subject categories Pediatrics, Neurosciences


Aim: To investigate long-term development of hand function after repeated botulinum neurotoxin A (BoNT-A) and occupational therapy at a young age. Method: Twenty children with unilateral spastic cerebral palsy (CP) (14 males, six females; median inclusion age 3y 1mo, range 1y 11mo–4y 3mo) participated in this longitudinal study. Ten children received occupational therapy after a randomized controlled trial and 10 repeated BoNT-A plus occupational therapy during 1-year. The Assisting Hand Assessment (AHA) and active supination, assessed the following 3 years. The assessments were compared with data from a reference group to investigate development over time. Results: The improvement in AHA (7.5 AHA units) after BoNT-A plus occupational therapy was maintained at final follow-up. The occupational therapy group, unchanged after 1-year, improved by 5 AHA units (96% confidence interval [CI] 2–10), thus there was no difference between the groups. Median active supination increased in comparison with the reference group. In the BoNT-A/occupational therapy group, 9 out of 10 (97.85% CI 45 115) children improved in active supination. In the occupational therapy group, 7 out of 10 (97.85% CI –2 to 68) children improved in active supination. No correlation between active supination and AHA was found. Interpretation: Bimanual performance achieved after BoNT-A plus occupational therapy was maintained, while it increased by follow-up in the occupational therapy group, suggesting that combined intervention gave earlier access to bimanual skills. Active supination was unrelated to AHA. © 2019 Mac Keith Press

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