{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T09:49:15Z","timestamp":1777888155358,"version":"3.51.4"},"reference-count":11,"publisher":"SAGE Publications","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PRM"],"published-print":{"date-parts":[[2020,11,23]]},"abstract":"<jats:p>PURPOSE: After the onset of the Coronavirus pandemic of 2019\u20132020 (COVID-19), physicians who inject OnabotulinumtoxinA (BoNT-A) were left with determining risks and benefits in pediatric patients with cerebral palsy. Many of these patients have pre-existing conditions that make them more prone to COVID-19 symptoms, and this susceptibility potentially increases after BoNT-A injections. METHODS: A retrospective chart review of 500 patients identified 256 pediatric patients with cerebral palsy who received an intramuscular BoNT-A injection to determine relative doses used for each Gross Motor Functional Classification Score (GMFCS). Data regarding age, weight, GMFCS, BoNT-A total body dosage, and inpatient hospitalizations for 6 months post-injection were collected. Differences between GMFCS levels were analyzed using one-way analysis of variance testing. Inpatient hospitalizations were recorded and assessed using relative risk to determine the population risk of hospitalization in the setting of initiating injections during the COVID-19 pandemic. RESULTS: Based on GMFCS level, patients who were GMFCS I or II received fewer units of BoNT-A medication per kilogram of body weight compared to GMFCS III\u2013V (p&lt; 0.0005, F= 25.38). There was no statistically significant difference in frequency or time to hospitalization when comparing patients receiving BoNT-A compared to a control group. CONCLUSIONS: Resumption of BoNT-A injections during the time of COVID-19 requires a systematic approach based on risks and potential benefits. Data from this analysis does not show increased risk for patients who received injections historically; however, recommendations for resumption of injections has not previously been proposed in the setting of a pandemic. In this manuscript, a tiered approach to considerations for injections was proposed. Botulinum toxin type A injections have a history of improving spasticity in the pediatric patient with cerebral palsy. Ensuring appropriate selection of patients for injection with BoNT-A during this pandemic is increasingly important.<\/jats:p>","DOI":"10.3233\/prm-200756","type":"journal-article","created":{"date-parts":[[2020,11,24]],"date-time":"2020-11-24T20:31:06Z","timestamp":1606249866000},"page":"273-279","source":"Crossref","is-referenced-by-count":0,"title":["A risk-stratified approach toward safely resuming OnabotulinumtoxinA injections based on dosing and ambulatory status in pediatric patients with cerebral palsy during the Coronavirus pandemic of 2019 (COVID-19)"],"prefix":"10.1177","volume":"13","author":[{"given":"Matthew J.","family":"McLaughlin","sequence":"first","affiliation":[{"name":"Children\u2019s Mercy Hospital Kansas City, MO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark T.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Children\u2019s Mercy Hospital Kansas City, MO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sathya","family":"Vadivelu","sequence":"additional","affiliation":[{"name":"Children\u2019s Mercy Hospital Kansas City, MO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"Ramsey","sequence":"additional","affiliation":[{"name":"Children\u2019s Mercy Hospital Kansas City, MO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denesh","family":"Ratnasingam","sequence":"additional","affiliation":[{"name":"Rehabilitation Institute of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"McGhee","sequence":"additional","affiliation":[{"name":"University of Missouri, Columbia, MO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kim","family":"Hartman","sequence":"additional","affiliation":[{"name":"Children\u2019s Mercy Hospital Kansas City, MO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","reference":[{"key":"10.3233\/PRM-200756_ref4","doi-asserted-by":"crossref","unstructured":"TeamCC-R., Coronavirus Disease 2019 in Children \u2013 United States, February 12\u2013April 2, 2020. MMWR Morbidity and Mortality Weekly Report 6 April 2020 [cited 2020 May 26]. Available from: doi: 10.15585\/mmwr.mm6914e4.","DOI":"10.15585\/mmwr.mm6914e4"},{"issue":"6","key":"10.3233\/PRM-200756_ref6","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1016\/j.apmr.2007.03.005","article-title":"Youth and young adults with cerebral palsy: their use of physician and hospital services","volume":"88","author":"Young","year":"2007","journal-title":"Archives of Physical Medicine and Rehabilitation"},{"issue":"2","key":"10.3233\/PRM-200756_ref7","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1111\/j.1469-8749.2009.03583.x","article-title":"Systemic adverse events following botulinum toxin A therapy in children with cerebral palsy","volume":"52","author":"Naidu","year":"2010","journal-title":"Developmental Medicine and Child Neurology"},{"issue":"3","key":"10.3233\/PRM-200756_ref8","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1111\/dmcn.13286","article-title":"Adverse drug reactions of botulinum neurotoxin type A in children with cerebral palsy: a pharmaco-epidemiological study in VigiBase","volume":"59","author":"Montastruc","year":"2017","journal-title":"Developmental Medicine and Child Neurology"},{"issue":"5","key":"10.3233\/PRM-200756_ref9","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1111\/dmcn.13686","article-title":"Severity of cerebral palsy and likelihood of adverse events after botulinum toxin A injections","volume":"60","author":"Swinney","year":"2018","journal-title":"Developmental Medicine and Child Neurology"},{"issue":"11","key":"10.3233\/PRM-200756_ref10","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1111\/dmcn.13995","article-title":"Systemic adverse events after botulinum neurotoxin A injections in children with cerebral palsy","volume":"60","author":"Paget","year":"2018","journal-title":"Developmental Medicine and Child Neurology"},{"issue":"8","key":"10.3233\/PRM-200756_ref11","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1111\/j.1469-8749.2008.03047.x","article-title":"Dysphagia in children with severe generalized cerebral palsy and intellectual disability","volume":"50","author":"Calis","year":"2008","journal-title":"Developmental Medicine and Child Neurology"},{"issue":"1","key":"10.3233\/PRM-200756_ref13","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.pmrj.2018.06.004","article-title":"Botulinum toxin: techniques within pediatric physiatry","volume":"11","author":"Paulson","year":"2019","journal-title":"PM & R: The Journal of Injury, Function, and Rehabilitation"},{"issue":"9","key":"10.3233\/PRM-200756_ref14","doi-asserted-by":"crossref","first-page":"e551","DOI":"10.1097\/BPO.0000000000001230","article-title":"Evidence-based recommendations for pediatric orthopaedic practice","volume":"38","author":"Kishore","year":"2018","journal-title":"Journal of Pediatric Orthopedics"},{"key":"10.3233\/PRM-200756_ref15","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1111\/dmcn.12962","article-title":"Injection frequency of botulinum toxin a for spastic equinus: a randomized clinical trial","volume":"58","author":"Hastings-Ison","year":"2016","journal-title":"Developmental Medicine and Child Neurology"},{"key":"10.3233\/PRM-200756_ref16","first-page":"260","article-title":"Botulinum toxin management and children with cerebral palsy","volume":"21","author":"Muktani","year":"2019","journal-title":"Pediatric Drugs"}],"container-title":["Journal of Pediatric Rehabilitation Medicine"],"original-title":[],"link":[{"URL":"https:\/\/content.iospress.com\/download?id=10.3233\/PRM-200756","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T04:37:09Z","timestamp":1777610229000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/full\/10.3233\/PRM-200756"}},"subtitle":[],"editor":[{"given":"Matthew","family":"McLaughlin","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Christian","family":"Vercler","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2020,11,23]]},"references-count":11,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3233\/prm-200756","relation":{},"ISSN":["1875-8894","1874-5393"],"issn-type":[{"value":"1875-8894","type":"electronic"},{"value":"1874-5393","type":"print"}],"subject":[],"published":{"date-parts":[[2020,11,23]]}}}