Combined Effect of Botulinum Toxin Type A Injection and Intensive Occupational Therapy in Treatment of Spastic Pronators in Children with Cerebral Palsy

ObjectiveBotulinum toxin type A (BtA) injection in the therapeutic treatment of muscle hypertonicity has been documented to reduce spasticity in specific muscle groups, with the effect lasting 1–3 months. The objective of this study was to evaluate the combined effect of an intensive occupational therapy (OT) programme following BtA injection in the treatment of spastic pronators in children with cerebral palsy.MethodsThis study used a pre/post intervention measurement design. Five children with cerebral palsy and hand function impairment were enrolled for intervention and followed-up longitudinally at 1, 3, 6 and 12 months. All patients received BtA injection to left pronators followed by OT according to treatment guidelines and standard assessment protocol. Outcome measures included change in spasticity, active range of motion (AROM), sensibility, power grip strength and functional hand grips.ResultsSignificant improvements in muscle tone, AROM, sensibility and functional hand grips were observed over time. The restoration of hand function and sensibility lasted up to 12 months after injection. In addition, we observed that four children gained sensibility, which did not demonstrate any tendency to diminish with time.ConclusionA combination of BtA injection and OT is effective for reducing spasticity in the pronators of children with cerebral palsy.