{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:02:19Z","timestamp":1790553739343,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2012,12,12]],"date-time":"2012-12-12T00:00:00Z","timestamp":1355270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Develop Med Child Neuro"],"published-print":{"date-parts":[[2013,3]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>Botulinum toxin A (BoNT\u2010A) 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\u2010A. Given the added burden for children and families, the aim of this study was to explore whether modified constraint\u2010induced movement therapy (<jats:styled-content style=\"fixed-case\">mCIMT<\/jats:styled-content>) leads to sufficiently superior gains compared with bimanual occupational therapy (BOT) in young children with unilateral CP following BoNT\u2010A injections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>In this randomized, controlled, evaluator\u2010blinded trial, 34 children (20 males, 14 females; mean age 3y, SD 1y 4mo, range 18mo\u20136y) with unilateral CP were randomized using concealed allocation to one of two 8\u2010week interventions. The experimental group (<jats:italic>n<\/jats:italic>=17) received BoNT\u2010A and <jats:styled-content style=\"fixed-case\">mCIMT<\/jats:styled-content>. The comparison group (<jats:italic>n=<\/jats:italic>17) received BoNT\u2010A 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\u00a0months. Secondary outcomes were measured at 3 months and 6\u00a0months using the Quality of Upper Extremity Skills Test, the Pediatric Evaluation of Disability Inventory, Canadian Occupational Performance Measure, and the Goal Attainment Scale.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were no clinically important differences between groups at baseline. Immediately following intervention, there was no evidence of a superior effect for BoNT\u2010A +\u00a0<jats:styled-content style=\"fixed-case\">mCIMT<\/jats:styled-content> as determined by the Assisting Hand Assessment (estimated mean difference [EMD] 0.81, upper 95% confidence limit 3.6; <jats:italic>p<\/jats:italic>=0.32) or secondary outcomes. However, both groups showed improvement over time (BoNT\u2010A\u00a0+\u00a0<jats:styled-content style=\"fixed-case\">mCIMT<\/jats:styled-content>: EMD 2.7, 95% confidence interval [CI] 0.7\u20135.2; BONT\u2010A\u00a0+\u00a0BOT: EMD 4.7, 95% CI 2.1\u20138.6). Follow\u2010up at 6\u00a0months also demonstrated no superior effect for BoNT\u2010A\u00a0+\u00a0<jats:styled-content style=\"fixed-case\">mCIMT<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Following upper limb injection of BoNT\u2010A, there was no evidence that <jats:styled-content style=\"fixed-case\">mCIMT<\/jats:styled-content>, 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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dmcn.12054","type":"journal-article","created":{"date-parts":[[2012,12,13]],"date-time":"2012-12-13T17:13:11Z","timestamp":1355418791000},"page":"238-247","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":80,"title":["Intensive therapy following upper limb botulinum toxin A injection in young children with unilateral cerebral palsy: a randomized trial"],"prefix":"10.1111","volume":"55","author":[{"given":"Brian","family":"Hoare","sequence":"first","affiliation":[{"name":"Department of Occupational Therapy La Trobe University Bundoora Australia"},{"name":"Victorian Paediatric Rehabilitation Service Monash Children's Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Imms","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy La Trobe University Bundoora Australia"},{"name":"Murdoch Childrens Research Institute Melbourne Australia"},{"name":"National Centre for Clinical Outcomes Research and School of Allied and Public Health Australian Catholic University Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elmer","family":"Villanueva","sequence":"additional","affiliation":[{"name":"Gippsland Medical School Monash University Churchill Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyam Barry","family":"Rawicki","sequence":"additional","affiliation":[{"name":"Victorian Paediatric Rehabilitation Service Monash Children's Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Matyas","sequence":"additional","affiliation":[{"name":"School of Psychological Sciences La Trobe University Bundoora Australia"},{"name":"Stroke Division Florey Institute of Neuroscience and Mental Health Heidelberg Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leeanne","family":"Carey","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy La Trobe University Bundoora Australia"},{"name":"Stroke Division Florey Institute of Neuroscience and Mental Health Heidelberg Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,12,12]]},"reference":[{"key":"e_1_2_13_2_1","first-page":"CD003469","article-title":"Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy (UPDATE)","volume":"1","author":"Hoare BJ","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.5014\/ajot.58.4.389"},{"key":"e_1_2_13_4_1","first-page":"CD004149","article-title":"Constraint\u2010induced movement therapy in the treatment of the upper limb in children with hemiplegic cerebral palsy","volume":"2","author":"Hoare BJ","year":"2007","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2005.tb01132.x"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2007.00806.x"},{"key":"e_1_2_13_7_1","first-page":"72","volume-title":"Christiansen CH, Baum CM, Editors. 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