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Botulinum Toxin Type A – Upper Limb Use for Children with Cerebral Palsy

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Kids living with cerebral palsy commonly experience tightness and/or weakness in the muscles of their arms and hands. This can impact their ability to be independent or do everyday tasks such as, for a young child, playing with toys, or for an older person, dressing themselves or playing sports. They may need different ways of doing these tasks or need to learn how to do these tasks differently.

Terms that may be used to describe tightness and/or weakness are ‘increased muscle tone,’ ‘spasticity,’ and ‘dystonia.’  

 

Aims of  therapy: 

The primary aim is to improve the person’s ability and independence to use their hands and/or arms for everyday life activities. 

A secondary aim is to prevent or reduce deformities, stiffness, or contractures of the muscles of their arms and hands which may occur due to the increased tone and/or weakness of the muscles. 

 

Therapy may include: 

  • Constraint Induced Movement Therapy  
  • Bi-manual Therapy 
  • Goal-directed motor training  
  • Stretches 
  • Splints for prolonged stretch or function 
  • Casting 
  • Tone management such as Botulinum toxin 

There is likely to be a combination of these, depending on individual needs, goals, and preferences. 

 

What is Constraint Induced Movement Therapy 

Constraint Induced Movement Therapy involves the constraint of the unaffected hand using a mitt or a cast, and the affected hand is used to practice specific activities to increase hand and functional skills. This is an intensive program that can be practiced at home, supported by an Occupational Therapist.   

 

What is Bi-manual Therapy? 

Bi-manual Therapy is an intensive home program supported by an Occupational Therapist. The focus is on using both hands (bi-manual) for a range of specific activities where the person practices and problem-solves.   

 

What is Goal Directed motor training? 

The person practices a specific task or goal that is important to them in real-life situations, such as goals related to play, mealtimes, and dressing. This is completed through an intensive program, practiced at home, childcare, kindy, school, at work, or in the community.  This training can focus on any daily activities. 

 

What is splinting and casting? 

Where muscles are tight and/or weak, a splint can be used to position the hand better and be more functional, or to stretch the muscles to improve the hand and/or arm movement. Splints can be worn overnight or during the day, depending on the purpose of the splint. 

Casting can also be used to increase the range of movement. A cast can be applied to the hand and/or arm and worn for a number of days at greater and greater angles to increase the range of movement.

 

What is Botulinum Toxin Type A (BoNT-A)? 

BoNT-A is a purified protein that, when injected into a muscle, where there is spasticity (high muscle tightness) causes partial paralysis and therefore reduces the spasticity and stiffness in the arm/hand. The effects of BoNT-A are not permanent, lasting 3-6 months.

BoNT-A can be considered for use for the following reasons as an adjunct to a therapy program:

  • To prevent the shortening of muscles 
  • To reduce pain or discomfort 
  • To improve the use of the arm and hand 

Our expert team of physiotherapists offer movement and mobility therapies for babies, kids, young people, and adults living with physical and intellectual disabilities and progressive disorders, as well as post-injury, neurological disorders such as cerebral palsy, and respiratory conditions including cystic fibrosis. We work closely with you and your family to monitor and treat movement disorders, and muscle and pain issues, utilising mobility and positional equipment, such as walkers, and therapeutic splinting.

If you would like information or free advice, speak to someone in our friendly team on 1300 668 482 or visit our Contact Us page for more ways to get in touch.