Effects of botulinum toxin type A and a programme of functional activity to improve manual ability in children and adolescents with cerebral palsy.

• We aimed to evaluate the effectiveness of a clinical programme that combined botulinum toxin injections with a functional activity programme to improve manual ability in children and adolescents with cerebral palsy. A total of 25 young people age range 2 to 19 years participated. They were given injections of botulinum toxin type A into spastic muscles in the upper extremities and participated in a functional activity training programme. Standardised clinical assessments were made before injections, one to two months after, and six months after, the final injections. To assess if the treatment had changed their ability to use the treated hand in activities of everyday life a questionnaire was given to the parents. The families thought that the ability had improved, and that the improvements took place both during the first three months after treatment and after more than six months after the final injections. The ability to extend wrist and fingers actively and the position of the thumb had improved significantly both in the short and long- term. This study supports the assumption that a programme combining botulinum toxin A injections with training in functional activity improves manual ability in young people with cerebral palsy.

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