2014 Medicine Psychology
SemanticScholar ID: 142528800 MAG: 1607113577

Does the use of home-based assistive rehabilitation technology enhance the functional benefits of botulinum toxin in children with cerebral palsy who have upper limb movement difficulties : a single-blind randomised controlled trial

Publication Summary

Background. Spastic cerebral palsy is a common cause of childhood activity limitation that restricts children’s personal development. Botulinum toxin is a spasticity treatment that can improve upper limb activity limitation when combined with rehabilitation therapy. We investigated whether use of a computer-assisted arm rehabilitation (CAAR) device enhanced the benefits of botulinum toxin treatment of the upper limb of children with cerebral palsy. Method. Fifteen children with cerebral palsy aged 5 – 12 years old undergoing botulinum toxin treatment for spasticity of the upper limb were randomly allocated into a CAAR group and a control group using minimisation, a procedure that balances groups for prognostic factors e.g. age and disability. Children used CAAR at home for 6 weeks. Assessments were carried out by blinded assessor at baseline, six and twelve weeks. Primary outcome measure. ABILHAND-kids. Secondary outcome measure. Canadian Occupational Performance Measure (COPM). Results. ABILHAND-kids. Activity limitation worsened following botulinum toxin treatment. An ANCOVA revealed that this was not significant (median scores, all participants: baseline, 0.8084; six weeks, 0.145; twelve weeks, 0.334; p=0.462) and that there was no difference between groups (p=0.699). COPM. A Friedman’s ANOVA revealed a statistically significant improvement that was clinically non-significant (baseline score, 4/10; six week score, 4.6/10; twelve week score, 4.6/10; p=0.031). A Kruskal-Wallis ANOVA revealed no difference in scores between groups at each time point. CAAR use. Mean daily use, 7 minutes. Maximum use, 256 minutes (played over 24 days, mean daily use 10.667 minutes). Sample size. This sample size was underpowered by 75%. Conclusion. This study potentially supports evidence that botulinum treatment should be used only in combination with rehabilitation therapy but it was not adequately powered and a Type II error cannot be ruled out. The CAAR device did not engage the children enough to promote sufficient intensity and repetition of arm movements.

CAER Authors

Avatar Image for Nick Preston

Dr. Nick Preston

University of Leeds - Research Fellow

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