Functional Outcomes of Intramuscular Botulinum Toxin Type A and Occupational Therapy in the Upper Limbs of Children With Cerebral Palsy: A Randomized Controlled Trial

Wallen, Margaret; O'Flaherty, Stephen; Waugh, Mary‐Clare

doi:10.1016/j.apmr.2006.10.017

Cited by 141 publications

(155 citation statements)

References 24 publications

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“…This might explain the high level of improvement in quality of movement and function by all children in the study, including those who did not receive BTX-A injection. Improvement was greater than that previously reported in similar studies of younger children (Fehlings et al 2000, Boyd et al 2003, Wallen et al 2004, and higher than the 4.5% change estimated to occur as a result of therapy intervention by QUEST test developers (DeMatteo et al 1992). Although the effectiveness of therapy alone is a good result, the marked clinical benefit provided by BTX-A is important.…”

Section: Pedimentioning

confidence: 51%

“…Goal Attainment Scaling (Kiresuk et al 1994) is recommended to identify clinically significant functional change after BTX-A injections (Russman et al 1997) and has been used in other BTX-A upper limb trials (Boyd et al 2003, Wallen et al 2004). The family developed their own 'family GAS' of three to five goals before the administration of COPM.…”

Section: Goal Attainment Scaling (Gas)mentioning

confidence: 99%

“…Reduction of spasticity in children with CP is clinically important because the following outcomes can occur: muscle length improvement leading to a slowing of contracture development rates (Corry et al 1997); improved tolerance of splinting and casting interventions, which increase range and function (Delgardo 2002); enhanced function (Russman et al 1997, Love et al 2001, Delgardo 2002, Boyd et al 2003; more opportunity for therapy interventions to be introduced (Russman et al 1997); and reduction in pain (Delgardo 2002). As recently as 2002 the use of BTX-A in the upper limb in CP was regarded as experimental (Wasiak et al 2002); however, expert clinical opinion about its potential (Russman et al 1997) is rapidly being complemented by positive findings of effect (Fehlings et al 2000, Boyd and Hays 2001, Boyd et al 2002, Wallen et al 2004.…”

mentioning

confidence: 99%

“…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. Ultrasound is an emerging localization technique (Westhoff et al 2003), and electrical stimulation has been shown to be more accurate in needle placement than manual techniques (Chin et al 2005).…”

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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Section: Pedimentioning

confidence: 51%

Section: Goal Attainment Scaling (Gas)mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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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“…18 In these studies, a total of 284 children were assessed with 859 GAS scales of varying quality, using a variety of scale development techniques in the different study designs. Five recent studies 3,18,19,20,23 evaluated BTX-A treatment. These studies found significant and clinically relevant effects of treatment with BTX-A as measured by GAS.…”

Section: Goal Attainment Scaling Used In Effect Studies In Paediatricmentioning

confidence: 99%

Goal attainment scaling in paediatric rehabilitation: a critical review of the literature

Steenbeek

Ketelaar

Galama

et al. 2007

Develop Med Child Neuro

194

146

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The aim of the study was to review the psychometric properties and use of goal attainment scaling (GAS) in paediatric rehabilitation research. We performed a critical literature review searching: (1) all studies whose main focus was to assess the psychometric properties of GAS in paediatric rehabilitation; and (2) all effect studies in paediatric rehabilitation that used GAS as one of the outcome measures. Three articles in the first group and six in the second group met the inclusion criteria. None of the studies had investigated the content reliability of the scales. Interrater reliability had been investigated in one study and had been found to be good. Only one trial had assessed the content validity of the developed scales, which was found to be acceptable. Comparisons showed that GAS, because of its idiosyncratic nature, measures different constructs from those measured by some related instruments. Low concurrent validity was found. All included studies reported good sensitivity to change. We conclude that the literature supports promising qualities of GAS in paediatric rehabilitation. GAS is a responsive method for individual goal setting and for treatment evaluation. However, current knowledge about its reliability when used with children is insufficient. There is a need for further development of GAS and its application for children of different ages and disabilities, across therapists of different disciplines.

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Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy

Hoare

Wallen

Imms

et al. 2003

The Cochrane Database of Systematic Reviews

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Functional Outcomes of Intramuscular Botulinum Toxin Type A and Occupational Therapy in the Upper Limbs of Children With Cerebral Palsy: A Randomized Controlled Trial

Cited by 141 publications

References 24 publications

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

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

Goal attainment scaling in paediatric rehabilitation: a critical review of the literature

Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy

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