Article

Botulinum toxin A (BoNT-A) combined with occupational therapy is effective
in improving upper limb outcomes in children with unilateral cerebral palsy (CP).
It is now essential to identify the most effective therapies following BoNT-A.
Given the added burden for children and families, the aim of this study was to
explore whether modified constraint-induced movement therapy (mCIMT) leads to
sufficiently superior gains compared with bimanual occupational therapy (BOT) in
young children with unilateral CP following BoNT-A injections. METHOD: In this
randomized, controlled, evaluator-blinded trial, 34 children (20 males, 14
females; mean age 3y, SD 1y 4mo, range 18mo-6y) with unilateral CP were
randomized using concealed allocation to one of two 8-week interventions. The
experimental group (n=17) received BoNT-A and mCIMT. The comparison group (n=17)
received BoNT-A and BOT. Participants were recruited from a physical
rehabilitation clinic and randomized between August 2003 and May 2009. Primary
outcome was measured using the Assisting Hand Assessment at 3 months. Secondary
outcomes were measured at 3 months and 6 months using the Quality of Upper
Extremity Skills Test, the Pediatric Evaluation of Disability Inventory, Canadian
Occupational Performance Measure, and the Goal Attainment Scale. RESULTS: There
were no clinically important differences between groups at baseline. Immediately
following intervention, there was no evidence of a superior effect for BoNT-A +
mCIMT as determined by the Assisting Hand Assessment (estimated mean difference
[EMD] 0.81, upper 95% confidence limit 3.6; p=0.32) or secondary outcomes.
However, both groups showed improvement over time (BoNT-A + mCIMT: EMD 2.7, 95%
confidence interval [CI] 0.7-5.2; BONT-A + BOT: EMD 4.7, 95% CI 2.1-8.6).
Follow-up at 6 months also demonstrated no superior effect for BoNT-A + mCIMT.
INTERPRETATION: Following upper limb injection of BoNT-A, there was no evidence
that mCIMT, despite the significantly increased intensity
of the home programme,
produced a superior effect across a range of outcomes compared with a structured
programme of BOT in young children with unilateral CP.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2012 Mac Keith
Press.

Langue : ANGLAIS