Functional electrical stimulation combined with botulinum toxin type A to improve hand function in children with spastic hemiparesis – a pilot study

Pieber, Karin; Herceg, Malvina; Wick, Franziska; Grim-Stieger, Martina; Bernert, G.; Paternostro-Sluga, Tatjana

doi:10.1007/s00508-010-1518-7

Cited by 14 publications

(11 citation statements)

References 14 publications

(20 reference statements)

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“…A number of BoNT-A studies have included static night splints as a component of UL intervention. 15,16,21,22,24 One study evaluated the additional effect of static night splints accompanying BoNT-A and OT and found improved quality of UL movement at 6 months postintervention compared with BoNT-A and OT alone. 21 This was a small study with poor methodologic quality, and findings need to be replicated in an adequately powered trial.…”

Section: Discussionmentioning

confidence: 99%

“…Thirteen types of UL interventions and numbers of participants were identified: NDT (2 studies; n = 122), 12,13 intramuscular injections of BoNT-A and OT (11 studies; n = 322), [14][15][16][17][18][19][20][21][22][23][24] cCIMT (3 studies; n = 56), 6,[25][26][27][28] mCIMT (15 studies; n = 578), 7,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] hybrid model (mCIMT and bimanual training; 2 studies; n = 68), 8,9 forced-use therapy (2 studies; n = 54), 48,49 HABIT (1 study; n = 20), 50 OT home programs (1 study; n = 35), 51 UL lycra splints (1 study; n = 16), 52 contextfocused therapy (1 study; n = 128), 53 mirror box therapy (1 study; n = 10), 54 acupuncture combined with OT (1 study; n = 75), …”

Section: Description Of Studiesmentioning

confidence: 99%

“…15,24 Home programs were provided in 4 studies, with minimal detail. 16,17,20,22 Total doses of therapy ranged from 4 to 78 hours. 15,19,24 Higher intensities and dosage of intervention were reported in studies of cCIMT, mCIMT, HABIT, and hybrid therapy.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Twelve studies were of very high methodologic quality, scoring $8 on the PEDro scale. 10 Fourteen studies were of poor methodologic quality, scoring ,6 on the PEDro scale (BoNT-A, [21][22][23] cCIMT, 6,25,26 mCIMT, 7,29,30,38,44 forced-use therapy, 48 and other UL interventions 50,54,56 ). Twenty-six studies (57%) did not report concealed allocation.…”

Section: Qualitative Assessmentmentioning

confidence: 99%

“…Data from 6 studies (9 publications) were not included in meta-analyses. One study reported median scores, 15 6 did not present summary statistics of central tendency and variability, 21,22,25,28,38,56 and 2 reported change scores with or without SDs. 41,55 For quantitative comparison of outcomes, data were available to pool across trials and 2 main comparisons were performed: (1) BoNT-A and OT versus OTalone and (2) cCIMT or mCIMT versus (a) a control group or therapy group receiving a lesser dosage of therapy or (b) a comparison group receiving an equivalent dosage of an alternative intervention.…”

Section: Qualitative Assessmentmentioning

confidence: 99%

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Efficacy of Upper Limb Therapies for Unilateral Cerebral Palsy: A Meta-analysis

2014

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BACKGROUND AND OBJECTIVE: Children with unilateral cerebral palsy present with impaired upper limb (UL) function affecting independence, participation, and quality of life and require effective rehabilitation. This study aims to systematically review the efficacy of nonsurgical upper limb therapies for children with unilateral cerebral palsy. METHODS: Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, the Cochrane Central Register of Controlled Trials, and PubMed were searched to December 2012. Randomized controlled or comparison trials were included. RESULTS: Forty-two studies evaluating 113 UL therapy approaches (N = 1454 subjects) met the inclusion criteria. Moderate to strong effects favoring intramuscular injections of botulinum toxin A and occupational therapy (OT) to improve UL and individualized outcomes compared with OT alone were identified. Constraint-induced movement therapy achieved modest to strong treatment effects on improving movement quality and efficiency of the impaired UL compared with usual care. There were weak treatment effects for most outcomes when constraint therapy was compared with an equal dose (amount) of bimanual OT; both yielded similar improved outcomes. Newer interventions such as action observation training and mirror therapy should be viewed as experimental. CONCLUSIONS: There is modest evidence that intensive activity-based, goal-directed interventions (eg, constraint-induced movement therapy, bimanual training) are more effective than standard care in improving UL and individualized outcomes. There is little evidence to support block therapy alone as the dose of intervention is unlikely to be sufficient to lead to sustained changes in UL outcomes. There is strong evidence that goal-directed OT home programs are effective and could supplement hands-on direct therapy to achieve increased dose of intervention.

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