Time-matched accelerometers on limbs and waist in children with CP give new insights into real-life activities after botulinum toxin treatment: A proof of concept study.
Stefan Gantelius, Sandra Vikerfors, Josefin Jansson Edqvist and 3 others
PMID 36314229WHAT IT FOUND
After botulinum toxin injections plus home training, children with cerebral palsy walked less from three weeks through three months.
In children injected in an arm, the more affected arm was not used more; the better arm was used more.
Key findings
01Time spent ambulating fell from 5.6% before injections to 4.7% at three weeks and 3.9% at three months.
02Children who received botulinum toxin type A in the arm did not increase voluntary hand use after injections; it was 53% before, 41% at three weeks and 46% at three months.
03Bimanual activity during voluntary arm use was 55% before injections in children injected in the arm and 37% in children injected only in the legs, and it did not change after injections in the arm-injected group.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only 11 children were included, and they differed in cerebral palsy subtype, age and muscles injected. The study had no control group and no power analysis, so it cannot show whether changes were due to treatment, training or natural variation. All children received home-based goal-oriented training after injections, so the separate contribution of botulinum toxin cannot be isolated. Some children did not complete every follow-up, and some accelerometer data were missing or failed to load. The accelerometers were uniaxial and sometimes not sufficiently fixed, and only one ankle was used. No typically developing children were included for comparison. There is no gold standard test for arm use in daily life. The children were in GMFCS I-III, so results may not apply to more severe mobility limitations. Follow-up was short, lasting three months, so later effects were not captured.
The easy way to misread this
Do not conclude that botulinum toxin alone caused less walking or changed arm use. This was a small pre-post observational study in which all children also received home-based goal-oriented training after injections, and some follow-up data were missing. The contribution of any single component cannot be separated.