Upper-limb injections of botulinum toxin-A in children with cerebral palsy: a critical review of the literature and clinical implications for occupational therapists.

This paper provides a review of the research literature that reports on the effectiveness of botulinum toxin-A (BtA) to reduce tone and improve functional use of the upper limbs of children who have cerebral palsy. Evaluation of the findings suggest that injections of BtA have demonstrated promising short-term results by reducing tone and increasing active range of motion in some children. Positive changes in function were also reported, however, only four studies used valid functional outcome measures. Children appropriate for BtA injections may be those with moderate tone, adequate grip strength, some distal voluntary control, intact sensation, and motivation to participate in postinjection training. Future research examining functional outcomes and the effect of repeated injections is needed. Active involvement of occupational therapists in the development and investigation of the most appropriate postinjection upper-limb training may help ensure optimal outcomes for children with cerebral palsy.