{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:10:48Z","timestamp":1790601048062,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,9,30]],"date-time":"2022-09-30T00:00:00Z","timestamp":1664496000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Develop Med Child Neuro"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To describe the use of upper\u2010limb botulinum neurotoxin A (BoNT\u2010A) treatment in a population\u2010based sample of children with cerebral palsy (CP), by investigating whether factors may be related to a first upper\u2010limb BoNT\u2010A treatment and whether passive range of motion (ROM) is related to a first BoNT\u2010A treatment after adjustment for confounders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Data from five regions in Sweden, in the national registry and follow\u2010up programme for CP (CPUP), were collected for children with spastic or dyskinetic CP assessed between 2000 and 2017. CP subtypes, functional classification levels, and traffic\u2010light\u2010based passive ROM categories were investigated. Data were analysed with logistic regression (odds ratios).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of a total of 496 children (317 males, 179 females; median 2\u2009years, interquartile range 1\u20135\u2009years, range 1\u201315\u2009years at first measurement occasion), 22% (<jats:italic>n<\/jats:italic>\u00a0=\u00a0108) had received upper\u2010limb BoNT\u2010A treatment, 45% of whom by 1 to 3\u2009years of age. Those classified in Manual Ability Classification System levels IV and V showed the highest crude odds ratio for a first upper\u2010limb BoNT\u2010A treatment. Children with full passive ROM with tightness at the end of the movement range were most likely to receive an upper\u2010limb BoNT\u2010A treatment, also after adjustment for confounders. Thumb and forearm muscles were the most targeted at the first upper\u2010limb BoNT\u2010A treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Full passive ROM with tightness at the end of the movement range increases the likelihood of a first upper\u2010limb BoNT\u2010A treatment. This new traffic\u2010light category is an aspect to consider in the dialogue about upper\u2010limb BoNT\u2010A.<\/jats:p><\/jats:sec><jats:sec><jats:title>What this paper adds<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Among children receiving upper\u2010limb botulinum neurotoxin A (BoNT\u2010A), 45% had their first treatment before the age of 4\u2009years.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Thumb and forearm muscles were the most treated with BoNT\u2010A, finger flexor muscles the least.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Full passive range of motion with tightness was related to first upper\u2010limb BoNT\u2010A treatment.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>","DOI":"10.1111\/dmcn.15426","type":"journal-article","created":{"date-parts":[[2022,9,30]],"date-time":"2022-09-30T09:45:15Z","timestamp":1664531115000},"page":"571-579","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Physical characteristics and upper\u2010limb treatment with botulinum neurotoxin A in children with cerebral palsy: A population\u2010based study"],"prefix":"10.1111","volume":"65","author":[{"given":"Jenny","family":"Hedberg\u2010Graff","sequence":"first","affiliation":[{"name":"Department of Women's and Children's Health Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredrik","family":"Granstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Health, Medicine and Caring Sciences Link\u00f6ping University  Link\u00f6ping Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Krumlinde\u2010Sundholm","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,9,30]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"8","article-title":"A report: the definition and classification of cerebral palsy April 2006","volume":"109","author":"Rosenbaum P","year":"2007","journal-title":"Dev Med Child Neurol Suppl"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0012162200001511"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-7-41"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2008.02.032"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)16207-7"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.30.12.1303"},{"key":"e_1_2_7_8_1","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":"2010","author":"Hoare BJ","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpn.2009.09.005"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/0883073814533196"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11832-014-0593-0"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-0712(03)00060-X"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/toxins7051629"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2010.03127.x"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40272-019-00344-8"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.3109\/09638288.2016.1161843"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.1997.tb07414.x"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2006.tb01313.x"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.12348"},{"key":"e_1_2_7_20_1","volume-title":"Measurement of joint motion\u00a0: a guide to goniometry","author":"Norkin CC","year":"2016"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.14006"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-017-1880-y"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-017-1880-y"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2011.03953.x"},{"key":"e_1_2_7_25_1","unstructured":"GlaasA.An investigation of reliability for House Functional Classification thumbs position according to House and the classification of Zancolli for children with cerebral palsy. 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