Prevalence of hand dysfunction in cerebral palsy following botulinum toxin therapy

Aim. To examine the level of dependence, the functional class, the most frequent type of compromise and the proprioception of the hand in spastic cerebral palsy following the application of botulinum toxin, as well as to determine the socio-demographic characteristics of the individuals involved. Patients and methods. We conducted a cross-sectional study of 21 spastic patients with extrinsic muscle involvement, of both sexes and a mean age of 15.4 +/- 5.6 years, who attended the neuro-rehabilitation outpatients department and were treated with botulinum toxin in the muscles responsible for the functional movements in the hand; they were evaluated after a mean period of 2.1 years. Patients were subjected to procedures such as a semi-structured interview, the FIM (Functional Independence Measurement) scale, Hausen's functional characterisation, Zancolli classification and a proprioception test. Results. There was a predominance of females (57% of patients) and of a basic level of schooling. On the FIM scale, 38% of the patients presented modified independence, without help; 23.8% belonged to Hansen grade 3 (grasping and holding an object steady with the help of the other hand). On the Zancolli classification, 54% belonged to type III (the fingers can only be extended if the fist is bent more than 70 degrees); perception of movement is absent (76.2%) and the sense of position of the movement is altered (54.2%). Conclusions. Findings confirmed the existence of a high rate of modified independence, grade 3 (Hausen), together with type III involvement (Zancolli) and alterations affecting proprioception. Data from the study show the importance of occupational therapy as part of the care received by patients with cerebral palsy following the administration of botulinum toxin type A.