The functional benefit and peripheral and central pathway changes derived from resistance training augmented with botulinum toxin A for the upper limb in children with spastic hemiplegia: a randomised controlled trial

[Truncated abstract] AIMS: This thesis investigated the impact of conventional therapy and resistance therapy augmented with botulinum toxin A (BoNTA) on upper limb (UL) function and the quality of UL movement in children with hemiplegic cerebral palsy (CP) as well as the neurophysiological mechanisms underpinning any improvements in function. METHOD/RESULTS: Two matched pair, randomised controlled trials (RCTs) investigated the effect of BoNTA on UL function in children with spastic hemiplegic CP. For the first study, younger aged children with spastic hemiplegia were matched on age and initial functional assessment score and allocated to a control group that continued conventional therapy or the treatment group receiving conventional therapy augmented with BoNTA. The length of time and response to BoNTA was measured using the Modified Ashworth Scale (MAS) and Modified Tardieu (MT). UL function was measured using the Quality of Upper Extremity Skills Test (QUEST) and Goal Attainment Scale (GAS) with UL performance and parent satisfaction with response to treatment measured using the Canadian Occupational Performance Measure (COPM). Conventional therapy, when augmented with BoNTA, resulted in greater improvements across outcome measures when compared with the control group. This first investigation did not allow for the intensity of therapy to be standardised nor determine whether altering the frequency or type of intervention would enhance the effects of the pharmacological management of the spasticity related to gains in UL function. As each subject maintained the same therapy regimen over the period of the study, it was difficult to ascertain if one approach to therapy was better augmented with BoNTA than another.