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August 16, 2026Journal of Children s OrthopaedicsOpen Access

Long-term functional decline following upper limb botulinum toxin injections in children with unilateral cerebral palsy: A preliminary retrospective 5-year follow-up case-control study

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Authors

ATAnne Tabard-FougèreABAlice Bonnefoy‐MazureSLSophie Louis

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Overview

Retrospective cohort study reveals long-term upper limb functional decline after botulinum toxin injections in children with cerebral palsy, indicating potential risks to motor capacity.

Key Points

  • To compare long-term upper extremity functional progression in children with spastic cerebral palsy receiving upper limb botulinum toxin A (BoNT-A) injections combined with physical therapy versus physical therapy alone.
  • Retrospective cohort study of 11 children aged 5–12 years with unilateral spastic cerebral palsy followed for ≥3 years (BoNT-A + PT, n=5; PT alone, n=6).
  • Assessed primary outcome of Assisting Hand Assessment (AHA) score change alongside secondary outcomes of maximal wrist extension and forearm supination via standardized video review by three blinded assessors.
  • Classified functional changes using minimal clinically important difference (MCID) thresholds: 5 units (AHA), 20° (wrist extension), and 30° (supination).
  • AHA scores deteriorated in all BoNT-A+PT patients (Δ = -3.6 ± 2.7) compared to functional improvements in 5 of 6 PT-alone patients (Δ = +9.0 ± 6.4).
  • Maximal wrist extension declined in all BoNT-A+PT patients (Δ = -53° ± 19°) versus 1 of 5 PT-alone patients (Δ = -4° ± 8°).
  • Forearm supination deteriorated in 4 of 5 BoNT-A+PT patients (Δ = -30° ± 7°) while remaining stable across all PT-alone patients (Δ = +2° ± 9°).

Cite This Study

Tabard-Fougère et al. (2026) studied this question.

synapsesocial.com/papers/6a8179eff2fb91fc834ad6c2https://doi.org/10.1177/18632521261475145
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Three‐year outcomes of repeated botulinum neurotoxin A injections to the lower extremities in young children with spastic cerebral palsy in <scp>GMFCS</scp> levels I to <scp>III</scp>2025 · 3 citations
  2. 2Longer‐term imaging of muscle quality after routine <scp>BoNT</scp> ‐A care in cerebral palsy: Beyond muscle volume2026
  3. 3Patient-Centred and Daily Life-Oriented Botulinum Toxin Treatment for Stroke Survivors with Upper Extremity Spasticity—Effects and Practical Aspects2025
  4. 4Patient-Centred and Daily Life-Oriented Botulinum Toxin Treatment for Stroke Survivors with Upper Extremity Spasticity—Effects and Practical Aspects2025
  5. 5Effect of Botulinum Toxin Type-A on Improvement of Muscle Function of Lower Limb in Children with Spastic Cerebral Palsy2024