Effects of botulinum toxin A and/or bimanual task-oriented therapy on upper extremity activities in unilateral Cerebral Palsy: a clinical trial

L. Speth*, Y. Janssen-Potten, E. Rameckers, A. Defesche, B. Winkens, J. Becher, R. Smeets, H. Vles

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: This study reports on the effects of botulinum toxin A (BoNT-A) injections in the upper extremity (UE)
in children with unilateral Cerebral Palsy (uCP) combined with bimanual task-oriented therapy (BITT) or either
treatment modality performed separately. Bimanual activities were measured with the Assisting Hand Assessment
(AHA), the ABILHand-Kids questionnaire (AK), the Observational Skills Assessment Score (OSAS). Goal achievement
was measured with Goal Attainment Scaling (GAS), using blind video assessment, and the Canadian Occupational
Performance Measure (COPM).
Methods: Thirty-five children, mean age 7.14 years (SD 2.63), 11 Manual Ability Classification Score (MACS) I, 15
MACS II and 9 MACS III, participated. The trial started with four study groups: BoNT-A-only (n = 5), BITT-only (n = 11),
BoNT-A + BITT (n = 13), and control (n = 6). Twenty-two children were randomised, 13 children received their
parents’ preferred treatment: BoNT-A + BITT or BITT-only. Three comparisons were analysed: BITT (BoNT-A + BITT and
BITT-only; n = 24) versus no BITT (BoNT-A-only and control; n = 11), BoNT-A (BoNT-A-only and BoNT-A + BITT; n = 18)
versus no BoNT-A (BITT-only and control; n = 17), and the additional effect of BoNT-A (BoNT-A + BITT versus BITT-only).
Follow-up time: 24 weeks.
Results: No significant differences between the groups were found on the AHA. The amount of use of both hands on
the OSAS was significantly better in the BoNT-A group in the beading and sandwich-making task. The BoNT-A group
also showed significant improvement in the quality scores of the OSAS: the wrist position during grasping and holding,
especially in the younger children. The BITT group improved significantly on the AK and significantly more on the
performance and satisfaction scores of the COPM at 12 and 24 weeks regarding several goals. BoNT-A showed a
significant negative effect at 12 and 24 weeks in the most important goal. BITT, more than BoNT-A + BITT, showed
positive effects on the GAS score at 12 (significant), 18 and 24 weeks.
Conclusions: BoNT-A has a positive effect on quality of movement and amount of use of the affected UE during the
3 months’ working time. BoNT-A has no additional effect on bimanual performance and goal achievement. BITT has a
positive effect on goal achievement and bimanual performance, even up to 6 weeks after therapy had stopped.
Trial registration: Current Controlled Trials ISRCTN69541857.
Original languageEnglish
Article number143
Number of pages15
JournalBMC Neurology
Early online date2 Nov 2015
Publication statusPublished - 2 Nov 2015

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