{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T09:50:17Z","timestamp":1777888217047,"version":"3.51.4"},"reference-count":23,"publisher":"SAGE Publications","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PRM"],"published-print":{"date-parts":[[2022,3,29]]},"abstract":"<jats:p>PURPOSE: The Gross Motor Functional Classification System (GMFCS) provides a standardized classification of motor disability in children with cerebral palsy (CP) that is typically considered longitudinally stable. Here, changes in GMFCS levels of children with CP who received repeated botulinum toxin A (BoNT-A) injections within an intensive rehabilitation approach were evaluated. METHODS: This retrospective, observational study included 503 children with CP (GMFCS I-V) treated in a single university rehabilitation clinic. Individualized treatment plans and a variety of rehabilitation techniques were incorporated within an integrated model of care. Each child received\u22652 repeated BoNT-A injections as well as an intensive rehabilitation program. RESULTS: GMFCS level following repeat treatment improved in 42.1% of the patients and worsened in 3 patients; 14.9% of children showed improvement after 1 treatment cycle, 12.3% after 2 cycles, 7.6% after 3 cycles, 3.6% after 4 cycles, and 3.8% after\u22655 cycles. Type of involvement (p\u200a&lt;\u200a0.001), baseline GMFCS (p\u200a=\u200a0.001), number of treatment cycles (p\u200a&lt;\u200a0.001) and presence of severe dystonia (p\u200a=\u200a0.032) were significant predictors of GMFCS improvement, but age and gender were not. CONCLUSION: Children with CP may change GMFCS level when intensive rehabilitation programs are combined with repeated BoNT-A injections.<\/jats:p>","DOI":"10.3233\/prm-210013","type":"journal-article","created":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T13:58:09Z","timestamp":1646747889000},"page":"107-112","source":"Crossref","is-referenced-by-count":1,"title":["GMFCS level improvement in children with cerebral palsy treated with repeat botulinum toxin injections and intensive rehabilitation: A retrospective study"],"prefix":"10.1177","volume":"15","author":[{"given":"Nigar","family":"Dursun","sequence":"first","affiliation":[{"name":"Kocaeli University Medical Faculty Department of Physical Medicine and Rehabilitation, Kocaeli, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Merve","family":"Akyuz","sequence":"additional","affiliation":[{"name":"Bursa State Hospital Department of Physical Medicine and Rehabilitation, Bursa, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tugba","family":"Gokbel","sequence":"additional","affiliation":[{"name":"Kocaeli University Medical Faculty Department of Physical Medicine and Rehabilitation, Kocaeli, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melike","family":"Akarsu","sequence":"additional","affiliation":[{"name":"Kocaeli University Medical Faculty Department of Physical Medicine and Rehabilitation, Kocaeli, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esin","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Kocaeli University Medical Faculty Department of Physical Medicine and Rehabilitation, Kocaeli, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cagla","family":"Karacan","sequence":"additional","affiliation":[{"name":"Gedik University Faculty of Sports Sciences, Istanbul, 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