Evaluating functional outcomes of botulinum toxin type a injection combined with occupational therapy in the upper limbs of children with cerebral palsy: A 9-month follow-up from the perspectives of both child and caregiver

Objective To assess the effectiveness of combining botulinum toxin type A (BoNT-A) with functional occupational therapy (OT) at 9-month follow-up in children with cerebral palsy (CP) with bilateral upper limb impairments from the perspectives of both child and caregiver. Methods Twelve children with CP and their caregivers were assessed across 5 time points over 9 months based on the ICF after BoNT-A injection and functional OT in this open-label study. Results Significant differences were found across the 5 time points (p < .05) for both grasp and visual-motor integration with small effects (effect sizes = 0.12-0.24) and the self-care capability and performance of social function (p < .05). However, based on the effect sizes (0.02-0.14), no significant effects were found at the 4 post-test time points. Small effects were found on the psychological domain (effect sizes = 0.25-0.37) and environmental domains (effect size = 0.27) at follow-ups. Conclusion Combining a BoNT-A injection with OT not only reduced the muscle tone and increased ROM but also improved the upper limb function and self-care capability in children with CP. More importantly, these effects persisted for up to 9 months. Functional OT extends the effectiveness of a BoNT-A injection.