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The objective of this study was to determine whether the use of intramuscular botulinum toxin A (BTX-A) increases upper limb function and skills in the context of a specific therapy programme in children with hemiparetic cerebral palsy. Twenty children (nine females, 11 males) aged 4 to 16 years who were thought likely to benefit from BTX-A treatment were included. After matched pairs were made, on the basis of Zancolli grade and age, randomization took place. All patients were given structured rehabilitation (physiotherapy and occupational therapy three times a week for 6 months), and half of the patients received intramuscular BTX-A. No placebo injections were given in the control group. Participants were assessed at baseline, at 2 and 6 weeks, and at 3, 6, and 9 months after injection. The Ashworth scale, active range of motion of arm joints, the Melbourne assessment of upper limb function, the Pediatric Evaluation of Disability Inventory, and the nine-hole peg test were used for outcome measurement. Observers were blinded for treatment allocation only for scoring the Melbourne test. The children in the treatment group showed a clinically relevant increase in active dorsal flexion, and tone reduction of the wrist. For the functional outcome measures, no statistically significant differences between the groups could be demonstrated. Intramuscular BTX-A added to an intensive therapy programme reduces impairment for at least 9 months; the effect on activity level is still uncertain.

Functional rehabilitation therapies for the upper extremity increase manual isometric flexor force at the wrist and ROM, but BTX injections cause weakness and do not lead to better outcomes than therapy alone.

SUMMARY Test‐retest reliability of measurements of peak aerobic power (cycle ergometer), anaerobic power (cycle ergometer), and isokinetic muscle strength of the knee (Cybex) was established in 12 young children with cerebral palsy (spastic diplegia/tetraplegia; mean age 8.8 years) and in addition in 39 healthy controls (mean age 9.2 years). The cycle ergometer tests were found to be reliable in both the group with CP and the control group (test‐retest correlations varying from 0.72 to 0.96). The isokinetic strength test in the group with CP was only reliable at 30o/s, whereas in the control group high test‐retest correlations were also found at 60%s and 120%. RÉSUMÉ Fidélité des tests de détermination de la puissante de pointe en aerobie et anaérobie, et de la force musculaire isocinétique chez les enfants IMC et les contrôles en bonne santé La fidélity test‐retest des mesures de puissance de pointe en aérobie (cycle ergomérique) et en anaérobie (cycle ergométrique), et la force musculaire isocinetique du genou (Cybex) chez 12 jeunes IMC à forme spastique, diplégique/tétraplégique (moyenne d‘âge 8.8 ans) et chez 39 contrôles en bonne santé“(moyenne d’âge 9.2 ans) Les tests d'ergométrie sur cycles se montrèrent fiables tant dans le groupe IMC que le groupe controle (corrélations test‐retest variant entre 0.72 et 0.96). Le test de force isocinétique dans le groupe IMC ne fut fidèle qu‘à 30%, tandis que dans le groupe. Contrôle des corrélations test‐retest élévens, à 60% et 120%étaient trouvées. ZUSAMMENFASSUNG Verlässlichkeit von Tests zur Bestimmung von Peak Aerobic Power, Anaerobic Power und isokinetischer Muskelkraft im Knie bei Kindern mit Cerebralparese und gesunden Kontrollen Bei 12 Kindern mit Cerebralparese und spastischer Diplegie/Tetraplegie (mittleres Alter 8.8 Jahre) und bei 39 gesunden Kontrollen (mittleres Alter 9.2 Jahre) wurde die Test‐retest Reliabilität von Messungen der Peak Aerobic Power (Fahrradergometer), der Anaerobic Power (Fahrradergometer) und der isokinetischen Muskelkraft im Knie (Cybex) untersucht. Die Fahrradergometer Tests erwiesen sich sowohl in der Gruppe mit Cerebralparese als auch in der Kontrollgruppe als verliBlich (Test‐retest Korrelationen zwischen 0.72 und 0.96). Der isokinetische Krafttest war in der Gruppe mit Cerebralparese nur bei 30% verläßlich, während in der Kontrollgruppe hohe Test‐retest Korrelationen bei 60% und 120% gefunden wurden. RESUMEN Fiabilidad de las pruebas para determinar el máximo de potencia aeróbica, anaeróbica y potencia muscular isoquinética, en niños con Parálisis Cerebral y en controles normales Se establecieron pruebas y contrapruebas de fiabilidad de las mediciones del pico de potencia aeróbica (bicicleta ergométrica), anaeróbica (bicicleta ergométrica) y potencia muscular isoquinética de la rodilla (Cybex) en 12 niños con parálisis cerebral y diplegia‐tetarplegia espástica (promedio de edad 8.8 años) y además en 39 controles sanos (edad promedio de 9.2 años). Se halló que lka bicicleta ergométrica constituia la prueba más fiable en el grupo co...

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Effects of functional electrical stimulation (FES) point towards a potential role as an alternative to orthoses for patients with spastic cerebral palsy (CP). Some evidence for a decrease in self-reported frequency of toe-drag and falls with the use of FES in spastic CP. Limited evidence for improvements in activity and participation in patients with spastic CP using FES.