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Botulinum toxin injection of biceps brachii significantly increases the efficacy of occupational therapy in hemiplegic cerebral pals: a randomised, double blinded, placebo controlled study.
Lookup NU author(s)
Professor Janet Eyre
Pearse J, Gibson M, Eyre JA
Conference Proceedings (inc. Abstract)
Developmental Medicine and Child Neurology: Third International Cerebral Palsy Conference
Year of Conference
18-21 February 2009
Number of Volumes
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Botulinum Toxin injection of Biceps Brachii significantly increases the efficacy of occupational therapy in hemiplegic cerebral palsy: a randomised, double blinded, placebo controlled study. HYPOTHESIS: Spasticity in Biceps Brachii contributes significantly to a reversible “never learned to use” component of the impairment of upper limb control in hemiplegic cerebral palsy. BACKGROUND: Children with hemiplegia often exhibit a reversible “never learned to use” component of the impairment of upper limb control. Spasticity of biceps brachii contributes significantly to this effect by inhibiting reach forward which is necessary for effective bimanual function. OBJECTIVE: To evaluate whether reduction in spasticity of Biceps Brachii by Botulinum Toxin injection improves the efficacy of occupational therapy for the paretic arm and hand. DESIGN: A randomised, double blinded, placebo controlled study. Ethical approval and informed parental and child consent were obtained. Subjects were randomised to Botulinum Toxin or Placebo Injection Groups, controlling for age, sex, hemiplegic side and degree of impairment. PARTICIPANTS/SETTING: 50 children (27 boys, age 4 – 17 years) MATERIALS/METHODS: All subjects received an individually tailored, occupational therapy programme promoting bimanual dexterity through the use of games. Primary outcome: Melbourne Assessment of Upper Limb Function; Secondary outcomes: Grip strength, adapted 9 Hole Pegboard Test, Canadian Occupational Performance Measure (COPM). Assessments were made at baseline before injections and at 3 and 6 months after injection (COPM baseline and 6 months only). Statistical analysis was by repeated measures ANCOVA with age as a covariate. RESULTS: Both Groups showed increased Melbourne (P=0.025), 9 Hole Peg Board (P=0.047) and COPM (P<0.001) Scores and increased Grip Strength (P=0.021) for the paretic arm over the 6 months. The rate of increase was significantly greater for the BTX Group for the Melbourne (P=0.023) and Peg Board (P=0.035) Scores. CONCLUSION: The use of Botulinum Toxin A injections to reduce spasticity in Biceps Brachii, significantly increases the efficacy of occupational therapy for the paretic arm and hand in hemiplegic cerebral palsy.
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