Upper-extremity Spasticity-reducing Treatment in Adjunct to Movement Training and Orthoses in Children with Cerebral Palsy at Gross Motor Function- and Manual Ability Classification System Levels IV-V: A Descriptive Study

ABSTRACT

Covering a 20-year period of work with children with severe cerebral palsy (CP) within a Swedish habilitation service, changes in passive wrist extension with fingers extended (PWE-FE) and current hand function are described and compared between children receiving systematic upper-extremity treatment with botulinum neurotoxin type A and intervention programs from before 7 years of age (Group 1, n = 7), those whom for various reasons did not undergo this treatment (Group 2, n = 10), and those not having the option to receive treatment until later during childhood/adolescence (Group 3, n = 8). Group 3 showed more critical and less normal PWE-FE values for both wrists, and poorer hand function scores, particularly compared with Group 1. Findings cautiously suggest that repeated upper-extremity spasticity-reducing treatment and movement training/orthoses from an early age may help prevent critical loss of passive range of motion of the wrist joint flexion/extension and promote hand function development in children with severe CP.

KEYWORDS:

• Severe cerebral palsy
• botulinum toxin
• upper-extremity interventions
• passive wrist extension
• hand function
• development

Acknowledgments

This study was financially supported by the Habilitation Center, Västerbotten County Council. Erik Domellöf is supported by the Knut and Alice Wallenberg Foundation under Grant number 2015.0192.

Declaration of interest statement

The authors have no conflicts of interest to disclose.

Additional information

Funding

This work was supported by the Vasterbotten’s County Council, Habilitation Center; Knut och Alice Wallenbergs Stiftelse [2015.0192].