Gross motor function
A high quality RCT (Scholtes et al, 2006) evaluated the combined effect on mobility of treatment with multilevel Botox and comprehensive rehabilitation in children with cerebral palsy. Significant between-group differences were found for GMFM at 24 and 48 weeks post treatment. However no significant between-group differences were found for energy cost. Generally, children at GMFCS Level III improved more 48 weeks post treatment than children at GMFCS Level I-II.
Conclusion: There is moderate evidence (level 1b) from one high quality RCT demonstrating that Botox and comprehensive rehabilitation improve gross motor function more than Botox alone in children with cerebral palsy.
Self-care/Life skills
A high level RCT (Wallen et al, 2007) investigated the functional outcomes of Botox injections to the upper limb in combination with OT in children with cerebral palsy. Subjects were separated into three group: Botox alone, Botox and OT, OT alone. The results indicated no between-group or intra-group differences in any of the groups on the Pediatric Evaluation of Disability Inventory. However, the Botox and OT group received the highest change in individualized measures of activity and participation (as measured by the GAS and COPM).
Conclusion: There is moderate evidence (level 1b) from one high quality RCT demonstrating that Botox and comprehensive rehabilitation does improve self-care/life skills in children with cerebral palsy depending on the outcome measure utilized.
Upper extremity function
A high level RCT (Rameckers et al, 2009) evaluated the effects of physical therapy, occupational therapy and Botox on the range of motion, spasticity and manual skills in children with hemiplegia. Results on the Melbourne Assessment of Unilateral Limb Function Melbourne did not demonstrate any significant improvement.
A high level RCT (Wallen et al, 2007) investigated the functional outcomes of Botox injections to the upper limb in combination with OT in children with cerebral palsy. Subjects were separated into three group: Botox alone, Botox and OT, OT alone. The Botox and OT group made statistically significant within group change at 3 months and so did the OT group at 6 months. There were no between group differences noted and all change was less than clinical significance. There were no significant inter- or intra-group differences in the QUEST scores.
Conclusion: There is conflicting evidence (level 4) from two high quality RCTs indicating that Botox in addition to therapy improve improves upper extremity function in children with cerebral palsy.
