Effects of botulinum toxin A injections and bimanual task-oriented therapy on hand functions and bimanual activities in unilateral Cerebral Palsy

Children with unilaterally impaired hand function due to spasticity tend to use the affected hand less and less during their development. This phenomenon is called ‘developmental disuse’. This dissertation shows that task-specific bimanual therapy is the first choice of treatment for the prevention of developmental disuse and the improvement of bimanual skills. In this type of therapy, the affected hand is forced to be used in tasks which are meaningful to child and parents, resulting in repetitive hand use in daily life.
Botulinum toxin injections are found to reduce strain and improve the quality of movement, which is measured by an instrument specifically designed for this purpose. However, they are shown to have a negative effect on strength and to have no added value to the use of the affected hand in daily life.