An evaluation of botulinum-A toxin injections to improve upper extremity function in children with hemiplegic cerebral palsy

Fehlings, Darcy; Rang, Mercer; Glazier, Janet; Steele, Catherine

doi:10.1067/mpd.2000.108393

Cited by 219 publications

(193 citation statements)

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“…workshops) was reported in 17 studies (28%), however, no study reported adequate details about the content or structure of training, whether there were training materials or where these could be accessed. A further 10 studies (17%) reported having procedure manuals, generic or standardized task specific therapy protocols Duncan, Shen, Zou, Han, Lu, Zheng et al, 2012;Fehlings, Rang, Glazier, & Steele, 2000;Gordon et al, 2011;Kawamura, Campbell, LamDamji, & Fehlings, 2007;Klingels et al, 2013;Olesch, Greaves, Imms, Reid, & Graham, 2010;Rameckers, Speth, Duysens, Vles, & Smits-Engelsman, 2009;Speth, Leffers, JanssenPotten, & Vles, 2005) to guide clinicians in the provision of therapy, however only three provided details that the protocols could be accessed on request (Duncan et al, 2012;Olesch et al, 2010;Sakzewski et al, 2015).…”

Section: Research Interventionsmentioning

confidence: 99%

Do we really know what they were testing? Incomplete reporting of interventions in randomised trials of upper limb therapies in unilateral cerebral palsy

Sakzewski

Reedman

Hoffmann

2016

Research in Developmental Disabilities

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Background: Incomplete reporting of components of interventions limits uptake of evidence into clinical practice. Aims:To evaluate the completeness of reporting of research and control interventions in randomised trials of upper limb therapies for children with unilateral cerebral palsy. Methods and procedures:Sixty randomized trials were included, encompassing 60 research and 68 control interventions. Using the 12-item Template for Intervention Description and Replication (TIDieR) checklist, two reviewers independently rated intervention and control descriptions.Outcomes and results: When using 50% of studies as the benchmark, five of the 12 TIDieR items for the research intervention, eight of the 12 items for the control intervention and 11 of 12 items for "usual care" interventions were inadequately reported. Procedures used to deliver the research intervention were adequately reported for 63% of studies. Materials were used in 94% of research interventions, yet only 27% provided details to access/replicate materials. Training materials for interventionists were used in 38% of trials, 10 (17%) had procedure manuals, yet only 3 reported details to access materials. The location where the research intervention was provided was detailed in 65% of studies. Reporting of all items was poorer for the control intervention. Conclusions:No study adequately reported all elements on the TIDieR checklist. Details crucial for replication of interventions and interpretation of results were missing. Authors, reviewers, and editors all have a responsibility to improve the quality of intervention reporting in published trials. The TIDieR guide is a potential solution, helping to structure accounts of interventions. What this study adds:This is the first study 3  This is the first study to evaluate the completeness of reporting of intervention components in complex cerebral palsy interventions  This is the first study to rate completeness of reporting of control interventions  This study provides information to increase awareness of editors, reviewers and authors of the importance of complete reporting of intervention components in cerebral palsy rehabilitation.

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Section: Research Interventionsmentioning

confidence: 99%

Do we really know what they were testing? Incomplete reporting of interventions in randomised trials of upper limb therapies in unilateral cerebral palsy

Sakzewski

Reedman

Hoffmann

2016

Research in Developmental Disabilities

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“…Test authors report that the use of less than the total four domains is psychometrically sound. QUEST at 6 months was chosen because there was known sensitivity to capture change in CP, investigators were interested in whether BTX-A injection effect plus therapy outlasted known pharmacological effect timelines, there was a precedent for its use with young children (Fehlings et al 2000), and psychometric properties were good (Hickey and Ziviani 1998). The total possible standard score across the two domains is 100.…”

Section: Quality Of Upper Extremity Skills Test (Quest)mentioning

confidence: 99%

“…Exclusion and inclusion criteria were based on previous study findings (Corry et al 1997, Fehlings et al 2000 and they proved to be both practical and useful in sample selection because a uniform and positive response to BTX-A was demonstrated. These characteristics might, therefore, provide useful clinical guides for the selection of very young children with CP for BTX-A intervention, particularly when high efficacy is required, spasticity is not severe, therapy is received, and upper limb quality of movement and function are intervention goals.…”

Section: Pedimentioning

confidence: 99%

“…The use of localization techniques is known to improve needle placement accuracy (Chin et al 2003). Manual localization techniques provide promising functional results (Corry et al 1997, Fehlings et al 2000. More recently, localization with the use of electrical stimulation has demonstrated good functional lower limb outcomes (Love et al 2001) and sustained improvement in the upper limb (Boyd et al 2003, Wallen et al 2004.…”

mentioning

confidence: 99%

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Low-dose/high-concentration localized botulinum toxin A improves upper limb movement and function in children with hemiplegic cerebral palsy

Lowe

Novak

Cusick

2006

Developmental Medicine &Amp; Child Neurology

104

121

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The objective was to determine the effects of low‐dose, high‐concentration, dual localized botulinum toxin A (BTX‐A) injections on upper limb movement quality and function. Study design was an evaluator‐blinded, randomized, controlled trial. Forty‐two children (31 males, 11 females; range 2–8y, mean 4y [SD 1.6]) with hemiplegic cerebral palsy (Gross Motor Function Classification System level I) participated. All received occupational therapy. The treatment group (n=21) received one injection series (mean muscles injected 6 [SD 1.05]; total dose 82–220 units, mean 139 [SD 37.48]; dilution 100 units/0.5ml). Primary outcome of Quality of Upper Extremity Skills Test (QUEST) at 6 months was not significant (p=0.318). Secondary outcomes were average treatment effects at 1, 3, and 6 months, which favoured the treatment group: QUEST (p<0.001); Canadian Occupational Performance Measure (performance, p=0.002; satisfaction p=0.007); parent Goal Attainment Scaling (GAS; p=0.001), therapist GAS (p<0.001); Pediatric Evaluation of Disability Inventory (PEDI) functional skills (p=0.030); Ashworth (p<0.001). PEDI caregiver assistance was not significant (p=0.140). Therapy alone is effective, but at 1 and 3 months movement quality is better where BTX‐A is also used. Moreover, function is better at 1, 3, and 6 months, suggesting BTX‐A enhances therapy outcomes beyond the pharmacological effect. One‐ and 3‐month Ashworth and QUEST scores suggest precise needle placement accuracy.

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“…Atualmente, o uso da toxina botulínica, em casos bem selecionados, tem se mostrado útil na prevenção de deformidades secundárias à espasticidade, modificando a qualidade de vida das crianças com PC [34][35][36][37][38] . A toxina botulínica é uma neurotoxina produzida pelo Clostrídio, que inibe a recaptação da acetilcolina na fenda sináptica da junção neuromuscular.…”

Section: Cerebral Palsy New Therapeutic Possibilitiesunclassified

Paralisia cerebral, novas perspectivas terapêuticas

Rotta¹

2002

J. Pediatr. (Rio J.)

119

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ResumoObjetivo: a revisão da paralisia cerebral tem como objetivo oferecer ao pediatra informações atualizadas sobre o diagnóstico e tratamento.Fontes dos dados: foram utilizados dados de revisão bibliográ-fica não sistematizada e da experiência no atendimento dos pacientes da Unidade de Neurologia do Serviço de Pediatria do HCPA-UFRGS. Síntese dos dados:o diagnóstico e tratamento da paralisia cerebral é multidisciplinar. Ao lado do sintoma principal motor, estão os sintomas associados que requerem igual atenção. Os exames de neuroimagem são importantes para melhor localizar a lesão, e mostrar sua extensão e características. O EEG auxilia no diagnóstico das epilepsias associadas. O tratamento principal é fisioterápico, auxiliado pelo tratamento da espasticidade, com antiespásticos orais, ou com toxina botulínica injetável. O tratamento de epilepsia secundária varia de acordo com o tipo de crise.Conclusões: o pediatra é o primeiro médico a entrar em contato com a criança com paralisia cerebral, e deve estar apto para reconhecer precocemente os desvios do desenvolvimento, orientar o manejo e, dentro das possibilidades e necessidades, encaminhar ao especialista. J Pediatr (Rio J) 2002; 78 (Supl.1):S48-S54: lesão cerebral, neurologia pediátrica, espasticidade. AbstractObjective: to provide pediatrician with updated information about diagnoses and treatment of cerebral palsy. This articles aims at supplying pediatricians with tools that will help them diagnose and treat cerebral palsy. Conclusions: pediatricians are the first physician that see the patient with cerebral palsy. Thus, they should be able to diagnose an treat it.J Pediatr (Rio J) 2002; 78 (Supl.1): S48-S54: cerebral palsy, neurology, pediatrics, spasticity.

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An evaluation of botulinum-A toxin injections to improve upper extremity function in children with hemiplegic cerebral palsy

Cited by 219 publications

References 18 publications

Do we really know what they were testing? Incomplete reporting of interventions in randomised trials of upper limb therapies in unilateral cerebral palsy

Do we really know what they were testing? Incomplete reporting of interventions in randomised trials of upper limb therapies in unilateral cerebral palsy

Low-dose/high-concentration localized botulinum toxin A improves upper limb movement and function in children with hemiplegic cerebral palsy

Paralisia cerebral, novas perspectivas terapêuticas

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