Cerebral Palsy• Botulinum toxin type-A (BoNT-A) and strength training are available interventions that, on their own have found success in managing spasticity and muscle weakness (both significant motor impairments), respectively in children with Cerebral Palsy (CP). • This study has demonstrated that the concurrent treatment of BoNT-A and strength training can achieve positive outcomes in terms of strength, spasticity and for the achievement of set functional goals. • The results of this study show that the improved muscle strength can be associated with hypertrophy, which could indicate the potential role of strength training in altering the rate of muscle growth, in an aim to improve the failure of muscle growth associated with CP. • Home based strength training, based on a child's individual goals is shown to be successful in improving strength and goal attainment for children with CP.

Elements contributing to meaningful leisure participation are interrelated. This review reveals the substantial contribution that meaningful interactions and relationships have in creating and facilitating positive and engaging experiences. Outcomes of this review may assist professionals in the design of targeted interventions to facilitate leisure participation. Implications for Rehabilitation Elements identified in this review may operate as core components of interventions that aim to optimise participation outcomes in community-based leisure activities. Supportive relationships and the availability of services are specific aspects of the environment that needs to be considered by health professionals to facilitate meaningful participation. Understanding the perspectives of the child is critical for assessing needs, preferences and goals relating to leisure participation in the community.

Aim With evidence for an atrophic effect of botulinum toxin type A (BoNT‐A) documented in typically developing muscles, this study investigated the immediate morphological alterations of muscles in children with cerebral palsy (CP) after BoNT‐A treatment. Method Fifteen children (10 males, five females; age range 5–11y, mean age 8y 5mo, SD 1y 10mo) with spastic diplegic CP [Gross Motor Function Classification System Levels I (n=9) and II (n=6)] receiving BoNT‐A injections for spasticity management were included. None of the children was a first‐time receiver of BoNT‐A. Magnetic resonance imaging and Mimics software assessed muscle volume, timed 2 weeks before and 5 weeks after injection. All participants received BoNT‐A bilaterally to the gastrocnemius muscle, and five participants also received BoNT‐A bilaterally to the medial hamstring muscles. Functional assessment measures used were the 6‐Minute Walk Test (6‐MWT), the Timed Up and Go (TUG) test, and hand‐held dynamometry. Results Whilst total muscle group volume of the injected muscle group remained unchanged, a 4.47% decrease in the injected gastrocnemius muscle volume (p=0.01) and a 3.96% increase in soleus muscle volume (p=0.02) was evident following BoNT‐A. There were no statistically significant changes in function after BoNT‐A as assessed by the TUG. There was also no statistically significant change in distance covered in the 6‐MWT. Muscle strength, as assessed using hand‐held dynamometry was also not statistically different after BoNT‐A treatment. Interpretation Muscle volume decreases were observed in the injected muscle (gastrocnemius), with synergistic muscle hypertrophy that appeared to compensate for this decrement. The 4% to 5% decrease in the volume of BoNT‐A injected muscles are not dramatic in comparison to reports in recent animal studies, and are a positive indication for BoNT‐A, particularly as it also did not negatively alter function.

Findings from this research will allow health professionals to optimise a holistic clinical service from a consumer's perspective at all stages of the burn journey. These research conclusions could be used for the development of protocols to underpin a comprehensive information and social support management plan for families that would complement and support the surgical, medical and therapeutic treatment plan, providing direction for comprehensive service delivery. Implications for Rehabilitation Health professionals should optimise a holistic clinical service from a consumer's perspective taking into consideration all stages of the burn journey. Therapeutic supports are required to target each phase of the burn journey and address changes in coping strategies and behavioural responses. There is a need for the development of protocols to underpin a comprehensive information and social support management plan for families that will complement and support the surgical and medical treatment plan.