{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:02:08Z","timestamp":1790553728436,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2009,7,3]],"date-time":"2009-07-03T00:00:00Z","timestamp":1246579200000},"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":[[2010,1]]},"abstract":"<jats:p><jats:bold>Aim\u00a0<\/jats:bold> To test the effectiveness of repeat botulinum toxin A (BoNT\u2010A) injections in the affected arm of 22 children with hemiplegic cerebral palsy (19 males, three females), aged 1\u2003year 10\u2003months to 4\u2003years 10\u2003months (mean 3y 8mo, SD 9mo) in a randomized controlled trial.<\/jats:p><jats:p><jats:bold>Method\u00a0<\/jats:bold> Children received either three series of BoNT\u2010A injections plus twice\u2010weekly occupational therapy (OT) or OT alone in 16\u2010week cycles. Muscles targeted at each injection cycle in the 11 children receiving BoNT\u2010A+OT were the adductor pollicis (<jats:italic>n=<\/jats:italic>9), flexor pollicis longus (<jats:italic>n=<\/jats:italic>5), flexor digitorum superficialis (<jats:italic>n=<\/jats:italic>8), flexor digitorum profundus (<jats:italic>n=<\/jats:italic>8), flexor carpi radialis (<jats:italic>n=<\/jats:italic>2), flexor carpi ulnaris (<jats:italic>n=<\/jats:italic>6), pronator teres (<jats:italic>n=<\/jats:italic>10), and biceps brachii (<jats:italic>n=<\/jats:italic>11). Parental perception of treatment efficacy was assessed using the Canadian Occupational Performance Measure (COPM) and the Goal Attainment Scale (GAS), quality of movement using the Quality of Upper Extremity Skills Test (QUEST), fine motor skills using the Peabody Developmental Motor Scale \u2013 Fine Motor (PDMS\u2010FM), and spasticity using the Modified Tardieu Scale (MTS). Between\u2010group differences at 12\u2003months were analysed using independent\u2010sample <jats:italic>t<\/jats:italic>\u2010tests.<\/jats:p><jats:p><jats:bold>Results\u00a0<\/jats:bold> All children were at Gross Motor Function Classification System levels I (BoNT\u2010A+OT <jats:italic>n=<\/jats:italic>6; OT <jats:italic>n=<\/jats:italic>8) or II (<jats:italic>n=<\/jats:italic>5 and <jats:italic>n=<\/jats:italic>3 respectively) and were too young to be classified using the Manual Ability Classification System. The BoNT\u2010A+OT group had higher COPM performance scores (mean difference \u22120.8, 95% confidence interval [CI] \u22121.5\u20130.0) and higher GAS T scores (mean difference \u22126.9, 95% CI \u221213.8 to \u22120.1]). No significant difference was found for the COPM satisfaction, PDMS\u2010FM, or QUEST scores. The BoNT\u2010A+OT group showed progressive reduction in spasticity compared with the OT group. At study completion MTS mean difference was 50.0\u00b0 (95% CI 22.4\u201377.6) for pronators and 20.9\u00b0 (95% CI 2.4\u201339.4) for wrist flexors.<\/jats:p><jats:p><jats:bold>Interpretation\u00a0<\/jats:bold> Repeat BoNT\u2010A injections in the upper limb combined with OT resulted in progressively reduced spasticity and improved parental perception of performance.<\/jats:p>","DOI":"10.1111\/j.1469-8749.2009.03387.x","type":"journal-article","created":{"date-parts":[[2009,7,3]],"date-time":"2009-07-03T13:44:24Z","timestamp":1246628664000},"page":"79-86","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":69,"title":["Repeat botulinum toxin\u2010A injections in the upper limb of children with hemiplegia: a randomized controlled trial"],"prefix":"10.1111","volume":"52","author":[{"given":"CHRISTINE A","family":"OLESCH","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SUSAN","family":"GREAVES","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CHRISTINE","family":"IMMS","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SUSAN M","family":"REID","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H KERR","family":"GRAHAM","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2009,12,18]]},"reference":[{"key":"e_1_2_7_2_2","volume-title":"Cerebral Palsies: Epidemiology and Causal Pathways","author":"Stanley F","year":"2000"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2005.00687.x"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.5014\/ajot.58.4.389"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0012162206000387"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2006.10.017"},{"key":"e_1_2_7_7_2","volume-title":"COPM: Canadian Occupational Performance Measure","author":"Law M","year":"2005"},{"key":"e_1_2_7_8_2","volume-title":"QUEST: Quality of Upper Extremity Skills Test","author":"DeMatteo C","year":"1992"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2000.105567"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.bpo.0000150819.72608.86"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/01202412-200511000-00001"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.1997.tb07408.x"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269215506073494"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1300\/J006v24n01_04"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/000841740407100406"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.1080\/09638280600929201"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269215506070703"},{"key":"e_1_2_7_18_2","volume-title":"Goal Attainment Scaling: Applications, Theory, and Measurement","author":"Kiresuk TJ","year":"1994"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.1999.tb00031.x"},{"key":"e_1_2_7_20_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0012162204000428"},{"key":"e_1_2_7_21_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1468-1331.2001.00047.x"},{"key":"e_1_2_7_22_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.322.7280.226"},{"key":"e_1_2_7_23_2","unstructured":"World Health Organisation.International Classification of Functioning Disability and Health (ICF): ICF Children and Youth Version.http:\/\/www.who.int\/classifications\/icf\/(accessed May 2009)."},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2007.00823.x"},{"key":"e_1_2_7_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2003.05.008"},{"key":"e_1_2_7_26_2","doi-asserted-by":"publisher","DOI":"10.1080\/11038120310004529"},{"key":"e_1_2_7_27_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2006.tb01313.x"},{"key":"e_1_2_7_28_2","doi-asserted-by":"publisher","DOI":"10.1053\/apmr.2003.50001"},{"key":"e_1_2_7_29_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006-2425"},{"key":"e_1_2_7_30_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2005.tb01173.x"},{"key":"e_1_2_7_31_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2007.00331.x"},{"key":"e_1_2_7_32_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2002-34500"}],"container-title":["Developmental Medicine &amp; 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