{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:05:23Z","timestamp":1790787923969,"version":"4.1.0"},"reference-count":18,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Children's Orthopaedics"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To compare long-term upper extremity functional evolution in children with spastic cerebral palsy (CP) receiving upper limb botulinum toxin A (BoNT-A) injections versus physical therapy (PT) alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This retrospective cohort study included children aged 5\u201312 years at baseline with \u22652 Assisting Hand Assessment (AHA) evaluations over \u22653 years. The primary outcome was AHA score change. Secondary outcomes included changes in maximal wrist extension and forearm supination during functional tasks, measured from standardized videos by three blinded assessors. Changes were classified using minimal clinically important difference (MCID) thresholds: 5 units (AHA), 20\u00b0 (wrist extension), and 30\u00b0 (supination).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eleven patients with unilateral spastic CP (BoNT-A+PT, n=5; PT alone, n=6) were included. All BoNT-A+PT patients demonstrasted AHA deterioration (\u0394 = \u20133.6 \u00b1 2.7), versus improvements in 5\/6 PT patients (\u0394 = +9.0 \u00b1 6.4). Wrist extension declined in all BoNT-A+PT patients (\u0394 = \u201353\u00b0 \u00b1 19\u00b0) versus 1\/5 PT patients (\u0394 = \u20134\u00b0 \u00b1 8\u00b0). Supination deteriorated in 4\/5 cases of BoNT-A+PT patients (\u0394 = \u201330\u00b0 \u00b1 7\u00b0) but remained stable in all PT patients (\u0394 = +2\u00b0 \u00b1 9\u00b0).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Upper limb BoNT-A was associated with systematic long-term functional decline, while PT alone preserved or improved function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance of Study<\/jats:title>\n                    <jats:p>These findings suggest that BoNT-A treatment may compromise long-term motor control and functional capacity, potentially influencing treatment algorithms in children with spastic cerebral palsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>III (retrospective cohort study).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/18632521261475145","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T03:53:11Z","timestamp":1786679591000},"page":"454-465","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term functional decline following upper limb botulinum toxin injections in children with unilateral cerebral palsy: A preliminary retrospective 5-year follow-up case-control study"],"prefix":"10.1177","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2231-1048","authenticated-orcid":false,"given":"Anne","family":"Tabard-Foug\u00e8re","sequence":"first","affiliation":[{"name":"Geneva University Hospitals and University of Geneva"},{"name":"Geneva University Hospitals and University of Geneva"},{"name":"Geneva University Hospitals and University of Geneva"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Bonnefoy-Mazure","sequence":"additional","affiliation":[{"name":"Geneva University Hospitals and University of Geneva"},{"name":"Geneva University Hospitals and University of Geneva"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Louis","sequence":"additional","affiliation":[{"name":"Geneva University Hospitals"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephane","family":"Armand","sequence":"additional","affiliation":[{"name":"Geneva University Hospitals and University of Geneva"},{"name":"Geneva University Hospitals and University of Geneva"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geraldo","family":"De Coulon","sequence":"additional","affiliation":[{"name":"Geneva University Hospitals and University of Geneva"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar","family":"Vazquez","sequence":"additional","affiliation":[{"name":"Geneva University Hospitals and University of Geneva"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.14957"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.15370"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.13106"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2023.103578"},{"key":"e_1_3_7_6_2","first-page":"1","article-title":"Botulinum Toxin in Children with Cerebral Palsy: An Update","volume":"51","author":"Hareb F","year":"2020","unstructured":"Hareb F, Bertoncelli CM, Rosello O, et al. Botulinum Toxin in Children with Cerebral Palsy: An Update. Neuropediatrics 2020; 51: 1\u20135. https:\/\/doi.org\/10.1055\/s-0039-1694988","journal-title":"Neuropediatrics"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(23)00004-2"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.13988"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.3390\/toxins17070327"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/mus.24763"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/PHM.0000000000002533"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.13168"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/2831342"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.14298"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2010.08.020"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.3390\/toxins14100676"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.3390\/toxins14020139"},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.3390\/toxins16020069"},{"key":"e_1_3_7_19_2","first-page":"529","article-title":"Tendon transfer surgery in upper-extremity cerebral palsy is more effective than botulinum toxin injections or regular, ongoing therapy","volume":"97","author":"Van Heest AE","year":"2015","unstructured":"Van Heest AE, Bagley A, Molitor F, et al. Tendon transfer surgery in upper-extremity cerebral palsy is more effective than botulinum toxin injections or regular, ongoing therapy. Journal of Bone and Joint Surgery - American 2015; 97: 529\u2013536. https:\/\/doi.org\/10.2106\/JBJS.M.01577","journal-title":"Journal of Bone and Joint Surgery - American"}],"container-title":["Journal of Children's Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/18632521261475145","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/18632521261475145","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/18632521261475145","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:52:28Z","timestamp":1790787148000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/18632521261475145"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":18,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1177\/18632521261475145"],"URL":"https:\/\/doi.org\/10.1177\/18632521261475145","relation":{},"ISSN":["1863-2521","1863-2548"],"issn-type":[{"value":"1863-2521","type":"print"},{"value":"1863-2548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]}}}