Wednesday, August 19, 2015

Botulinum toxin A with Occupational Therapy OR OT Alone - Botox+OT is Superior at 12 months

Botulinum toxin A injections and occupational therapy in children with unilateral spastic cerebral palsy: a randomized controlled trial




To investigate the effects of repeated botulinum toxin A (BoNT-A) injections combined with occupational therapy, including a splint, compared with occupational therapy alone on hand function in children with unilateral spastic cerebral palsy (USCP), in all International Classification of Functioning, Disability and Health (ICF) domains.


This was a randomized controlled study, population-based and evaluator-blinded for primary outcome (October 2004 to September 2010). Twenty children (14 males; median age 3y 1mo) with USCP, recruited at a rehabilitation centre in Sweden, were assigned to one of two parallel groups using concealed allocation. In the course of one year, 10 children received occupational therapy, while 10 received repeated BoNT-A plus occupational therapy (BoNT-A/OT). Primary outcome (Assisting Hand Assessment [AHA]), and secondary outcome measures (range of movement [ROM], and Canadian Occupational Performance Measure), were measured at baseline, 3, 6, 9, and 12 months.


AHA revealed a superior effect in the BoNT-A/OT group at 12 months: 6 out of 10 improved compared with 1 out of 10 in the occupational therapy group (p<0 .03="" 0.01="" 0.81.="" 95="" a="" as="" both="" confidence="" difference="" exact="" for="" given="" groups.="" improved="" in="" interval="" is="" outcomes="" p="" peskun="" proportions="" secondary="" the="" to="">


Repeated BoNT-A/OT appeared superior to occupational therapy alone for bimanual performance in young children with USCP. Active ROM and goal performance improved in both groups.

Assisting Hand Assessment
Botulinum toxin A plus occupational therapy
Canadian Occupational Performance Measure
International Classification of Functioning, Disability and Health for Children and Youth
Range of movement
Smallest detectable difference
Unilateral spastic cerebral palsy

No comments: