@article{Zelnik1997,
  abstract = {The use of botulinum toxin in cerebral palsy is still experimental. We conducted a pilot clinical trial with botulinum toxin injections on 14 children with spastic cerebral palsy. All patients were mobile with dynamic contractures of the gastrocnemius-soleus muscles. The injections were monophasic in 9 patients and biphasic in 5 patients. Improvement in dorsiflexion, quality of gait and grade of independence were achieved in 3 patients; improvement in dorsilflexion and quality of gait were achieved in 6 patients. There was no significant change in quality of gait in 4 patients. The beneficial effect lasted 4-9 months (mean 6.7 months). A combined functional score given by the physicians, therapists and parents showed a marked improvement in 6 patients (42.9\%), a mild improvement in 3 patients (21.4\%) and no improvement in 5 patients (35.7\%). Biphasic injections were slightly more effective than monophasic injections (p < 0.02). Adverse effects were usually mild. We conclude that botulinum toxin may be used for the reduction of spasticity in patients with cerebral palsy who have dynamic deformities of the ankle joints.},
  added-at = {2014-07-20T09:30:56.000+0200},
  author = {Zelnik, N. and Giladi, N. and Goikhman, I. and Keren, G. and Moris, R. and Honigman, S.},
  biburl = {https://www.bibsonomy.org/bibtex/2ec645c3087122d1830cff69c53347e9e/ar0berts},
  groups = {public},
  interhash = {48ad1600b658875b026bd22e5cb6bd6e},
  intrahash = {ec645c3087122d1830cff69c53347e9e},
  journal = {Isr J Med Sci},
  keywords = {Activities of Daily Living; Botulinum Toxin Type A; Cerebral Palsy; Child; Child, Preschool; Female; Gait; Humans; Leg; Male; Muscle Spasticity; Neuromuscular Agents; Pilot Projects; Prospective Studies; Range Motion, Articular; Time Factors; Treatment Outcome},
  month = Feb,
  number = 2,
  pages = {129--133},
  pmid = {9254875},
  timestamp = {2014-07-20T09:30:56.000+0200},
  title = {The role of botulinum toxin in the treatment of lower limb spasticity in children with cerebral palsy--a pilot study.},
  username = {ar0berts},
  volume = 33,
  year = 1997
}

@article{Zuercher2001,
  abstract = {Intramuscular botulinum toxin A (BTA) injection has a role in the conservative management of dynamic equinus deformity in children with cerebral palsy. The effect of BTA injection of the gastrocsoleus muscle during gait was evaluated. Eight children with hemiplegia (median age 4.4 years, range 2 to 8 years) were included in this retrospective study. Assessment included kinematic and kinetic gait analysis before and after (median 57.5 days) treatment. Postinjective kinematics showed significant improvement of ankle range of motion in the stance phase of gait. Ankle kinetics demonstrated a significant decrease of pathological power generation in midstance. The ankle power quotient (APQ) was also significantly improved. Ankle power in terminal stance was improved, although not to a significant level. These results provide evidence of normalization of energy production at the ankle, which is critical for normal gait. The effect of BTA is temporary and can be successfully repeated. This allows deferring the need for surgical intervention until the child is older and recurrence rate is lower.},
  added-at = {2014-07-20T09:30:27.000+0200},
  author = {Z?rcher, A. W. and Molenaers, G. and Desloovere, K. and Fabry, G.},
  biburl = {https://www.bibsonomy.org/bibtex/2ca09916018085f154b6c1fd32ceff709/ar0berts},
  groups = {public},
  interhash = {daf5d239b4810512e564459e5ecdb0d2},
  intrahash = {ca09916018085f154b6c1fd32ceff709},
  journal = {Acta Orthop Belg},
  keywords = {Ankle Joint; Biomechanics; Botulinum Toxin Type A; Cerebral Palsy; Child; Child, Preschool; Equinus Deformity; Female; Gait Disorders, Neurologic; Humans; Infant; Injections, Intramuscular; Kinetics; Male; Neuromuscular Agents; Treatment Outcome},
  month = Dec,
  number = 5,
  pages = {475--480},
  pmid = {11822078},
  timestamp = {2014-07-20T09:30:27.000+0200},
  title = {Kinematic and kinetic evaluation of the ankle after intramuscular injection of botulinum toxin A in children with cerebral palsy.},
  username = {ar0berts},
  volume = 67,
  year = 2001
}

@article{Yang2003,
  abstract = {OBJECTIVE: The objective of this study was to investigate the effects of botulinum toxin type A injections in reducing upper limb muscular spasticity and in improving motor function in children with cerebral palsy. DESIGN: Fifteen children with spastic cerebral palsy who were undergoing regular physical and occupational therapy were enrolled. Botulinum toxin type A injections in clinically indicated target muscle groups were administered after the children had received 3 mo of therapy. A follow-up study was carried out at 6 wk and 12 wk, respectively, after the botulinum toxin type A injections. The main outcome measurements included the Modified Ashworth Scale, the upper limb Physician's Rating Scale, the Bruininks-Oseretsky Test of Motor Proficiency, and the self-care domain of the Pediatric Evaluation of Disability Inventory. RESULTS: The reduction of spasticity in the treated muscle groups differed significantly between the control period and both study periods. Improvements on the Physician's Rating Scale score during the study period also differed significantly as compared with improvements during the control period. There was a significant difference in the improvement of fine motor skills, as measured with Bruininks-Oseretsky Test of Motor Proficiency, between the control period and both study periods. Improvements in self-care capability differed significantly between the control period and 12 wk after botulinum toxin type A treatment, but not between the control period and at 6 wk after treatment. Muscle strength of grasp and pinch did not differ significantly between the control and the study period. Distribution of body parts involvement, disease severity, and function in daily living activities had no significant correlation with functional improvement after the treatment. CONCLUSIONS: Our findings support the premise that botulinum toxin type A injections are effective in reducing upper limb spasticity and in improving movement pattern and fine motor function of patients with spastic cerebral palsy. A reduction in caregivers' burden and improved quality of life were demonstrated through the study period.},
  added-at = {2014-07-20T09:29:54.000+0200},
  author = {Yang, Tsui Fen and Fu, Chung Pei and Kao, Nien Tzu and Chan, Rai Chi and Chen, Shu Jen},
  biburl = {https://www.bibsonomy.org/bibtex/23ba6c617366a5e4ec8d9155857a2492d/ar0berts},
  doi = {10.1097/01.PHM.0000056989.67763.07},
  groups = {public},
  interhash = {5475f05b06f0b17fdd3781ca29d4ea16},
  intrahash = {3ba6c617366a5e4ec8d9155857a2492d},
  journal = {Am J Phys Med Rehabil},
  keywords = {Adolescent; Botulinum Toxin Type A; Cerebral Palsy; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Injections, Intramuscular; Male; Muscle Hypertonia; Spasticity; Neurologic Examination; Neuromuscular Agents; Treatment Outcome; Upper Extremity},
  month = Apr,
  number = 4,
  pages = {284--289},
  pii = {00002060-200304000-00006},
  pmid = {12649654},
  timestamp = {2014-07-20T09:29:54.000+0200},
  title = {Effect of botulinum toxin type A on cerebral palsy with upper limb spasticity.},
  url = {http://dx.doi.org/10.1097/01.PHM.0000056989.67763.07},
  username = {ar0berts},
  volume = 82,
  year = 2003
}

@article{Worley2003,
  abstract = {SUMMARY: OBJECTIVE To present three cases of inspiratory stridor caused by laryngeal dystonia (LD) in children with cerebral palsy (CP), one of whom is being treated by periodic botulinum toxin type A (BTX) injection into a vocalis muscle, thereby avoiding tracheostomy.STUDY DESIGN Case series.RESULTS AND CONCLUSIONS Laryngeal dystonia was diagnosed in three children with CP who presented with inspiratory stridor associated with generalized dystonia, all of whom were thought previously to have had laryngomalacia. The inspiratory stridor was severe enough in one patient that a tracheostomy was planned. In common with the movement disorder of generalized dystonia, the inspiratory stridor caused by LD was present in our patients when they were awake, worse when they were excited or agitated, diminished when they were awake and calm, and absent when they were asleep. Although there is overlap between the symptoms of LD and laryngomalacia (and other structural causes of upper airway obstruction) in children with CP, structural causes result in inspiratory stridor that is often persistent when patients are awake and relaxed or when they are asleep. Fiberoptic laryngoscopy in an awake patient with LD reveals vocal cord adduction in inspiration causing inspiratory stridor in association with generalized dystonia. Baclofen and gabapentin used together relieved the inspiratory stridor and improved the generalized dystonia of two patients, confirming the clinical diagnosis of LD, but for the last 2 years the third patient (the one with the most severe inspiratory stridor) also has required a periodic BTX injection into a vocalis muscle (the major vocal cord adductor) to relieve her inspiratory stridor, alternating the side of injection. Her mother considers this is a small price to pay to avoid tracheostomy. This is the first report of LD causing inspiratory stridor in patients with CP and the first reported use of BTX injection into a vocalis muscle for relief of inspiratory stridor due to LD in a child.},
  added-at = {2014-07-20T09:28:16.000+0200},
  author = {Worley, Gordon and Witsell, David L and Hulka, Gregory F},
  biburl = {https://www.bibsonomy.org/bibtex/2c47faf0d106793c31aa4800830a35f24/ar0berts},
  groups = {public},
  interhash = {49189a8b83d84c25f4e1340ab4a59c2b},
  intrahash = {c47faf0d106793c31aa4800830a35f24},
  journal = {Laryngoscope},
  keywords = {Botulinum Toxin Type A; Cerebral Palsy; Child, Preschool; Dystonia; Humans; Laryngeal Diseases; Laryngoscopy; Respiratory Sounds; Tracheostomy},
  month = Dec,
  number = 12,
  pages = {2192--2195},
  pmid = {14660926},
  timestamp = {2014-07-20T09:29:02.000+0200},
  title = {Laryngeal dystonia causing inspiratory stridor in children with cerebral palsy.},
  username = {ar0berts},
  volume = 113,
  year = 2003
}

@article{Wong2002,
  abstract = {The objective of this study was to assess the efficacy of botulinum toxin for upper limb spasticity in cerebral palsy. An open-label study was conducted in 11 children with cerebral palsy. Post-botulinum toxin assessment was conducted in weeks 1, 4, and 16, with averaged scores being analyzed. The Clinical Global Impression Scale of the mothers showed marked, moderate, and mild improvement in five, four, and two cases, respectively. The Modified Ashworth Spasticity Scale score showed a statistically significant decrease in the mean spasticity score (P < .003). Other tests were performed depending on the cognition of the child. Increase in joint motion occurred in all five children assessed using web space (P = .043). For the Jebson Hand Function Test, improvement occurred in all five cases assessed (P < .03). Four of five (80\%) children could perform tasks that they failed before they were given botulinum toxin. Botulinum toxin is useful in decreasing spasticity and improving the upper limb function of young children with cerebral palsy with normal cognition. Motivated families should be selected with a specific target of using botulinum toxin as an adjunct in a habilitation program.},
  added-at = {2014-07-19T21:56:31.000+0200},
  author = {Wong, Virginia and Ng, Annie and Sit, Patsy},
  biburl = {https://www.bibsonomy.org/bibtex/28d72716e2774b000e607e3f1cd105c21/ar0berts},
  groups = {public},
  interhash = {0962248970f1e7c191d08601a1a9dfde},
  intrahash = {8d72716e2774b000e607e3f1cd105c21},
  journal = {J Child Neurol},
  keywords = {Adolescent; Arm; Botulinum Toxin Type A; Cerebral Palsy; Child; Child, Preschool; Female; Humans; Injections, Intramuscular; Male; Motor Skills; Muscle Spasticity; Neurologic Examination; Treatment Outcome},
  month = Feb,
  number = 2,
  pages = {138--142},
  pmid = {11952075},
  timestamp = {2014-07-19T21:56:31.000+0200},
  title = {Open-label study of botulinum toxin for upper limb spasticity in cerebral palsy.},
  username = {ar0berts},
  volume = 17,
  year = 2002
}

@article{Wong1998,
  abstract = {The use of botulinum toxin was studied in 17 children with spastic cerebral palsy to determine its efficacy and tolerability. Eleven ambulatory and 6 nonambulatory patients were included. All children were undergoing a physiotherapy program with monitoring of their baseline states for 3 months before botulinum toxin injection. The effect was evident within 72 hours. The peak effect was noticed by 1 to 2 weeks in the majority; the effect lasted for 3 to 10 months. All children experienced decreased spasticity scores. Their functional status improved, with three nonambulatory children becoming ambulatory with assistance and five children with assisted ambulation becoming more independently ambulatory. Measurement of joint motion showed improvement in the range of motion as compared with baseline. Video analysis of the functional state in the nonambulatory or gait in the ambulatory children revealed improvement in all. The functional status of rising from the sitting position or standing demonstrated improvement. None of the children had any untoward side effects except mild transient pain at the injection site. This study demonstrated botulinum toxin is useful as an adjunctive therapy in ameliorating spasticity in children with cerebral palsy, especially in the younger ones.},
  added-at = {2014-07-19T21:56:31.000+0200},
  author = {Wong, V.},
  biburl = {https://www.bibsonomy.org/bibtex/294208ecb982ad694e993822de4197801/ar0berts},
  groups = {public},
  interhash = {1338b257bb298f0f5edb068d0ad417a3},
  intrahash = {94208ecb982ad694e993822de4197801},
  journal = {Pediatr Neurol},
  keywords = {Activities of Daily Living; Adolescent; Botulinum ; Cerebral Palsy; Chi-Square Distribution; Child; Child, Preschool; Female; Follow-Up Studies; Gait; Humans; Male; Neuromuscular Agents; Toxin Type A; Treatment Outcome},
  month = Feb,
  number = 2,
  pages = {124--131},
  pii = {S0887899497001641},
  pmid = {9535297},
  timestamp = {2014-07-19T21:56:31.000+0200},
  title = {Use of botulinum toxin injection in 17 children with spastic cerebral palsy.},
  username = {ar0berts},
  volume = 18,
  year = 1998
}

@article{Wong2003,
  abstract = {A systematic review with the Sachett model of evidence-based medicine of the use of Botulinum toxin type A (BTX) for intervention in children with Cerebral Palsy (CP) is highlighted. Currently, the evidence showed that BTX is useful for treating pes equinus due to spasticity of the gastrocnemius-soleus muscles. However, careful patient selection and goals of treatment have to be addressed. More multi-centre clinical trials with standardized protocols are needed before widespread recommendation of the use of BTX in treating spasticity in CP can be made.},
  added-at = {2014-07-19T21:56:30.000+0200},
  author = {Wong, Virginia},
  biburl = {https://www.bibsonomy.org/bibtex/29f26f268dc2e95587df27543e339cd5f/ar0berts},
  doi = {10.1080/1363849031000139306},
  groups = {public},
  interhash = {975417a0bc47f924e2c7bdd5580b60d6},
  intrahash = {9f26f268dc2e95587df27543e339cd5f},
  journal = {Pediatr Rehabil},
  keywords = {Botulinum Toxin Type A; Cerebral Palsy; Evidence-Based Medicine; Humans; Neuromuscular Agents},
  number = 2,
  pages = {85--96},
  pii = {XKAF4JG2PXGFEAQK},
  pmid = {14534045},
  timestamp = {2014-07-19T21:56:30.000+0200},
  title = {Evidence-based approach of the use of Botulinum toxin type A (BTX) in cerebral palsy.},
  url = {http://dx.doi.org/10.1080/1363849031000139306},
  username = {ar0berts},
  volume = 6,
  year = 2003
}

@article{Wong2005a,
  abstract = {OBJECT: Both botulinum toxin type A (BTA) injection and selective posterior rhizotomy (SPR) are well-recognized treatments for children with spastic cerebral palsy (CP); however, there has been no study in which the long-term effectiveness of these two approaches has been compared. METHODS: The study population comprised 62 ambulatory children with spastic diplegic CP who were participating in the same rehabilitation program and 19 healthy volunteers. The children with CP were divided into the following three groups: BTA (22 cases), SPR (20 cases), and no treatment (20 cases); the healthy volunteers served as the control group. A computer-assisted gait analysis system was used to assess gait performance. Gait was assessed in the three groups of children at 1 week before treatment, and 3, 6, 12, and 20 months after treatment. Based on the analysis of walking velocity, cadence, and step length, the BTA group demonstrated rapid improvement posttreatment but the improvement became insignificant after 12 months even with repeated BTA injections at 4-month intervals. In contrast, the SPR group displayed initial deterioration of gait parameters during the first 3 months posttreatment and then improved continuously from 6 to 20 months. The control group did not display a significant change in gait. CONCLUSIONS: The findings suggest that the effectiveness of BTA injection is more short-lived and SPR initially decreases gait performance but is expected to improve gait performance at between 6 and 20 months after the procedure.},
  added-at = {2014-07-19T21:56:27.000+0200},
  author = {Wong, Alice M K and Pei, Yu-Cheng and Lui, Tai-Ngar and Chen, Chia-Ling and Wang, Chin-Man and Chung, Chia-Ying},
  biburl = {https://www.bibsonomy.org/bibtex/20dc4cf8b07989346e64fc4457e977d3e/ar0berts},
  groups = {public},
  interhash = {bd8706f386289b8d302603ce4398cc0a},
  intrahash = {0dc4cf8b07989346e64fc4457e977d3e},
  journal = {J Neurosurg},
  keywords = {Botulinum Toxin Type A; Cerebral Palsy; Child; Child, Preschool; Female; Gait; Humans; Injections; Male; Rhizotomy},
  month = May,
  number = {4 Suppl},
  pages = {385--389},
  pmid = {15926389},
  timestamp = {2014-07-19T21:56:27.000+0200},
  title = {Comparison between botulinum toxin type A injection and selective posterior rhizotomy in improving gait performance in children with cerebral palsy.},
  username = {ar0berts},
  volume = 102,
  year = 2005
}

@article{Wong2004a,
  abstract = {OBJECTIVE: To compare the treatment effectiveness of botulinum toxin type A (BTX-A) and phenol blocks in managing lower limb spasticity and gait dysfunction in children with cerebral palsy. DESIGN: This is a case-controlled study that took place in a tertiary center's gait laboratory. A total of 27 ambulatory children with cerebral palsy spastic diplegia, aged from 3 to 7 yrs, and 20 normal children were recruited into this study. Sixteen children with cerebral palsy received BTX-A injections, and 11 received phenol motor point blocks. Gait analyses were assessed by a portable computer-assisted system (Computer DynoGraphy, Infotronic, The Netherlands). Both the BTX-A and phenol groups received gait analysis at 1 wk before and 2 mos after injection treatments. RESULTS: Significant improvements in gait variables of velocity and cadence were noted in children with cerebral palsy after BTX-A injections as compared with the phenol block group. Gaitline and cyclogram patterns also improved significantly in the BTX-A group. The adverse clinical effects of BTX-A injections were less severe as compared with phenol injections. CONCLUSIONS: BTX-A injections demonstrated superior treatment effects in improving gait variables and patterns in children with spastic diplegia as compared with phenol blocks. BTX-A injections also revealed fewer clinical side effects and were well tolerated by children with cerebral palsies.},
  added-at = {2014-07-19T21:56:27.000+0200},
  author = {Wong, Alice M K and Chen, Chia-Ling and Chen, Carl P C and Chou, Shih-Wei and Chung, Chia-Ying and Chen, Max J L},
  biburl = {https://www.bibsonomy.org/bibtex/2758857c61cd27475f203e1aa560999ca/ar0berts},
  groups = {public},
  interhash = {7d52067cc7a57f01f28f27905ec0af55},
  intrahash = {758857c61cd27475f203e1aa560999ca},
  journal = {Am J Phys Med Rehabil},
  keywords = {Botulinum Toxin Type A; Case-Control Studies; Cerebral Palsy; Child; Child, Preschool; Electromyography; Female; Gait; Humans; Injections, Intramuscular; Lower Extremity; Male; Muscle Spasticity; Neuromuscular Agents; Blockade; Phenol; Treatment Outcome},
  month = Apr,
  number = 4,
  pages = {284--291},
  pii = {00002060-200404000-00008},
  pmid = {15024330},
  timestamp = {2014-07-19T21:56:27.000+0200},
  title = {Clinical effects of botulinum toxin A and phenol block on gait in children with cerebral palsy.},
  username = {ar0berts},
  volume = 83,
  year = 2004
}

@article{Wolf2006,
  abstract = {A methodological modular framework is presented for automated assessment of gait patterns. The processing steps of data selection, gait parameter calculation and evaluation are not limited to a specific field of application and are largely independent of case-based clinical expert knowledge. For these steps, a variety of mathematical methods was used and the validity of the approach to assess gait parameters tested by applying it to the clinical problem of Botulinum Toxin A (BTX-A) treatment of the spastic equinus foot. A set of 3670 parameters was ranked by relevance for classification of a group of 42 diplegic cerebral palsy (CP) patients and an age-matched reference group. The same procedure was performed for pre- and post-therapeutic data sets of these patients. Gait parameters of high relevance coincided well with results of previous studies based on partly manual and more subjective parameter selection. A norm distance measure is introduced to facilitate the quantification of deviations from a normal walking pattern and can be used as an overall scalar measure to evaluate differences in gait patterns or as a set of measures attributing each joint angle separately.},
  added-at = {2014-07-19T21:56:23.000+0200},
  author = {Wolf, Sebastian and Loose, Tobias and Schablowski, Matthias and D?derlein, Leonhard and Rupp, R?diger and Gerner, Hans J?rgen and Bretthauer, Georg and Mikut, Ralf},
  biburl = {https://www.bibsonomy.org/bibtex/215e0955474c625bd5c0542bb912a95fa/ar0berts},
  doi = {10.1016/j.gaitpost.2005.04.004},
  groups = {public},
  interhash = {2a77c7f218fd2962a401d9a68690ca9e},
  intrahash = {15e0955474c625bd5c0542bb912a95fa},
  journal = {Gait Posture},
  keywords = {Automation; Botulinum Toxin Type A; Cerebral Palsy; Child; Equinus Deformity; Female; Gait Disorders, Neurologic; Humans; Male; Muscle Spasticity; Neuromuscular Agents},
  month = Apr,
  number = 3,
  pages = {331--338},
  pii = {S0966-6362(05)00054-8},
  pmid = {15955701},
  timestamp = {2014-07-19T21:56:23.000+0200},
  title = {Automated feature assessment in instrumented gait analysis.},
  url = {http://dx.doi.org/10.1016/j.gaitpost.2005.04.004},
  username = {ar0berts},
  volume = 23,
  year = 2006
}

@article{Wissel1999,
  abstract = {The present study was performed to assess dose-response relationships of local botulinum toxin A (BtxA) treatment in children and teenagers with spastic gait due to cerebral palsy (CP) in a randomized, double-blind study employing a "high-dose" (200 units Botox per leg) and a "low-dose" (100 units Botox per leg) treatment arm in 33 patients with CP. Response parameters included changes in muscle tone assessed by the Ashworth scale at knee joint, range-of-motion (ROM) measurements at knee and ankle joint, objective analysis of longitudinal gait parameters as well as subjective assessments of improvement. Patients in the "high-dose" arm received 40-80 units Botox/muscle versus 20-40 units Botox/muscle in the "low-dose" group. Patients in both treatment arms showed significant improvement of Ashworth score (p<0.001) and ROM (p<0.01), while gait analysis revealed significant increase in gait velocity (p<0.01) and stride-length (p<0.001) over baseline. Subjects in the "high-dose" group showed significantly greater improvement on objective response measurements compared to "low-dose" patients. Also, children aged 7 years or less had greater functional benefit compared to the subgroup of patients older than 7 years. Incidence and severity of side-effects were similar in both treatment groups. The present study demonstrated dose-dependent functional improvement of dynamic deformities and spastic gait pattern in children and young adults with CP treated with local injections of botulinum toxin. A dose of 200 units Botox per leg distributed to 4 or 5 muscle bellies per leg is superior compared to 100 units Botox per leg without significantly affecting the risk of side-effects.},
  added-at = {2014-07-19T21:56:18.000+0200},
  author = {Wissel, J. and Heinen, F. and Schenkel, A. and Doll, B. and Ebersbach, G. and M?ller, J. and Poewe, W.},
  biburl = {https://www.bibsonomy.org/bibtex/24a5e5b2df18b2f2cc45004f58a79f7d3/ar0berts},
  groups = {public},
  interhash = {fbad6ea5ea3bcc5e15e4e2c033aaa94c},
  intrahash = {4a5e5b2df18b2f2cc45004f58a79f7d3},
  journal = {Neuropediatrics},
  keywords = {Adolescent; Adult; Botulinum Toxin Type A; Cerebral Palsy; Child; Child, Preschool; Dose-Response Relationship, Drug; Double-Blind Method; Female; Gait; Humans; Injections, Intramuscular; Male; Muscle Spasticity},
  month = Jun,
  number = 3,
  pages = {120--124},
  pmid = {10480205},
  timestamp = {2014-07-19T21:56:18.000+0200},
  title = {Botulinum toxin A in the management of spastic gait disorders in children and young adults with cerebral palsy: a randomized, double-blind study of "high-dose" versus "low-dose" treatment.},
  username = {ar0berts},
  volume = 30,
  year = 1999
}

@article{Willenborg2002,
  abstract = {Symptomatic hip flexion deformity secondary to iliopsoas spasticity may interfere with gait, impair sitting balance, or contribute to hip subluxation or dislocation. A nonsurgical, minimally invasive technique to ameliorate iliopsoas spasticity is presented. The technique uses intramuscular injections of botulinum A toxin to provide selective neuromuscular blockade of the iliacus or psoas muscles or both. Because of the anatomic location of the target muscles, this technique uses ultrasound guidance for needle placement. Active electromyographic stimulation is used to verify the needle position adjacent to active myoneural interfaces. The authors' experience to date includes the treatment of 28 patients (53 hips). Use of this technique has resulted in improved hip range of motion. No intraoperative or postoperative adverse events or complications have been observed.},
  added-at = {2014-07-19T21:55:00.000+0200},
  author = {Willenborg, Michael J and Shilt, Jeffrey S and Smith, Beth Paterson and Estrada, Roquel L and Castle, Jason A and Koman, L. Andrew},
  biburl = {https://www.bibsonomy.org/bibtex/2b5a40a2413034ba3a126162d36841855/ar0berts},
  groups = {public},
  interhash = {2e5623981cae14645b3b57b19f5ce9a9},
  intrahash = {b5a40a2413034ba3a126162d36841855},
  journal = {J Pediatr Orthop},
  keywords = {Botulinum Toxin Type A; Cerebral Palsy; Electromyography; Female; Hip; Humans; Injections, Intramuscular; Male; Psoas Muscles},
  number = 2,
  pages = {165--168},
  pmid = {11856922},
  timestamp = {2014-07-19T21:55:00.000+0200},
  title = {Technique for iliopsoas ultrasound-guided active electromyography-directed botulinum a toxin injection in cerebral palsy.},
  username = {ar0berts},
  volume = 22,
  year = 2002
}

@article{Weigl2007,
  added-at = {2014-07-19T21:54:25.000+0200},
  author = {Weigl, Daniel M and Arbel, Nili},
  biburl = {https://www.bibsonomy.org/bibtex/27425ecf90abff5213a28185247f6d086/ar0berts},
  groups = {public},
  interhash = {e1edf59fcf9b99764d14a5014edd98ea},
  intrahash = {7425ecf90abff5213a28185247f6d086},
  journal = {Dev Med Child Neurol},
  keywords = {Botulinum Toxin Type A; Cerebral Palsy; Child, Preschool; Humans; Neuromuscular Agents; Withholding Treatment},
  month = Feb,
  number = 2,
  pages = {159--160},
  pmid = {17297747},
  timestamp = {2014-07-19T21:54:25.000+0200},
  title = {Why do children with cerebral palsy discontinue therapy with botulinum toxin A?},
  username = {ar0berts},
  volume = 49,
  year = 2007
}

@article{Wasiak2002,
  added-at = {2014-07-19T21:54:09.000+0200},
  author = {Wasiak, Jason and Hoare, Brian J and Hender, Kim M},
  biburl = {https://www.bibsonomy.org/bibtex/23b6127590698f46238e5f710427c2672/ar0berts},
  groups = {public},
  interhash = {d524ad7b9bbe474eac38781b07bb4cab},
  intrahash = {3b6127590698f46238e5f710427c2672},
  journal = {Med J Aust},
  keywords = {Arm; Botulinum Toxin Type A; Cerebral Palsy; Child; Humans; Injections, Intramuscular; Neuromuscular Agents; Randomized Controlled Trials; Treatment Outcome},
  month = Aug,
  number = 3,
  pages = 158,
  pii = {was10310_fm},
  pmid = {12149089},
  timestamp = {2014-07-19T21:54:09.000+0200},
  title = {Does intramuscular botulinum toxin A injection improve upper-limb function in children with hemiplegic cerebral palsy?},
  username = {ar0berts},
  volume = 177,
  year = 2002
}

@article{Wasiak2004,
  abstract = {BACKGROUND: Cerebral palsy (CP) is a central nervous system deficit resulting from a non-progressive lesion in the developing brain. Although the brain lesions are static, the movement disorders that arise are not unchanging and are characterised by atypical muscle tone, posture and movement (Rang 1990). The spastic motor type is the most common form of CP and its conventional therapeutic management may include splinting/casting, passive stretching, facilitation of posture and movement, spasticity-reducing medication and surgery. More recently, health care professionals have begun to use botulinum toxin A (BtA) as an adjunct to interventions in an attempt to reduce muscle tone and spasticity to improve function OBJECTIVES: To assess the effectiveness of intramuscular BtA injections as an adjunct to managing the upper limb in children with spastic CP. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003), MEDLINE (1966 to March Week 3 2004), EMBASE (1980 to 2003 Week 16) and CINAHL (1982 to Week 3 March 2004). SELECTION CRITERIA: All randomised controlled trials (RCTs) comparing intramuscular BtA injections into any muscle group of the upper limb with placebo, no treatment or other interventions. DATA COLLECTION AND ANALYSIS: Two authors using standardised forms extracted the data independently. Each trial was assessed for internal validity with differences resolved by discussion. Data was extracted and entered into RevMan 4.2.3. MAIN RESULTS: Two trials met the inclusion criteria, each having short-term follow up, a small number of subjects and using a single set of injections.The study by Corry 1997 compared BtA with an injection of normal saline and found promising results in elbow extension, elbow and wrist muscle tone. At three months, encouraging results for wrist muscle tone and grasp and release were noted. The trial reported median change, range of changes and the difference in these measures between groups. The study by Fehlings 2000 compared BtA with no intervention. When data were analysed no treatment effect was found for quality of upper limb function, passive range of motion, muscle tone, grip strength or self-care ability. REVIEWERS' CONCLUSIONS: This systematic review has not found sufficient evidence to support or refute the use of intramuscular injections of BtA as an adjunct to managing the upper limb in children with spastic cerebral palsy. Only one of the two identified RCTs reported some promising results in support of reduced muscle tone following BtA injections. Further research incorporating larger sample sizes, rigorous methodology, measurement of upper limb function and functional outcomes is essential.},
  added-at = {2014-07-19T21:54:08.000+0200},
  author = {Wasiak, J. and Hoare, B. and Wallen, M.},
  biburl = {https://www.bibsonomy.org/bibtex/2f8435912a9eeedfb1857e40227299b3c/ar0berts},
  doi = {10.1002/14651858.CD003469.pub3},
  groups = {public},
  interhash = {476b218bbb259b0367bb13e00abb6314},
  intrahash = {f8435912a9eeedfb1857e40227299b3c},
  journal = {Cochrane Database Syst Rev},
  keywords = {Adolescent; Arm; Botulinum Toxin Type A; Cerebral Palsy; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Injections, Intramuscular; Muscle Spasticity; Neuromuscular Agents},
  number = 4,
  pages = {CD003469},
  pmid = {15495055},
  timestamp = {2014-07-19T21:54:08.000+0200},
  title = {Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy.},
  url = {http://dx.doi.org/10.1002/14651858.CD003469.pub3},
  username = {ar0berts},
  year = 2004
}

@article{Ward2006,
  abstract = {Botulinum toxin type-A (BoNT-A) prevents the release of acetylcholine at cholinergic junctions, thereby causing temporary muscle weakness lasting 3-4 months. It is now widely used to treat a broad range of clinical disorders characterized by muscle hyperactivity. BoNT-A has proved effective in the management of several neurological conditions and, in particular, in the management of movement disorders (e.g. blepharospasm, cervical dystonia, laryngeal dystonia, limb dystonia, hemifacial spasm, focal tics, tremor and other hyperkinetic disorders). As a treatment of spasticity, BoNT-A can improve mobility and dexterity as well as preventing the development of distressing and costly secondary complications. In cerebral palsy, BoNT-A is of value, being able to delay or even avoid surgery until motion patterns have become established.},
  added-at = {2014-07-19T21:54:06.000+0200},
  author = {Ward, A. B. and Molenaers, G. and Colosimo, C. and Berardelli, A.},
  biburl = {https://www.bibsonomy.org/bibtex/2ce905f9fa6509de3427f19b733545058/ar0berts},
  doi = {10.1111/j.1468-1331.2006.01650.x},
  groups = {public},
  interhash = {42dfc7a8341e14079f523aa45bb85d2f},
  intrahash = {ce905f9fa6509de3427f19b733545058},
  journal = {Eur J Neurol},
  keywords = {Adult; Botulinum Toxin Type A; Cerebral Palsy; Child; Humans; Movement Disorders; Muscle Spasticity; Nervous System Diseases; Neuromuscular Agents},
  month = Dec,
  pages = {20--26},
  pii = {ENE1650},
  pmid = {17112346},
  timestamp = {2014-07-19T21:54:06.000+0200},
  title = {Clinical value of botulinum toxin in neurological indications.},
  url = {http://dx.doi.org/10.1111/j.1468-1331.2006.01650.x},
  username = {ar0berts},
  volume = {13 Suppl 4},
  year = 2006
}

@article{Wallen2007,
  abstract = {OBJECTIVE: To investigate the functional outcomes of botulinum toxin type A (BTX-A) injections to the upper limb in combination with occupational therapy (OT) in children with cerebral palsy (CP). DESIGN: Randomized controlled trial with follow-up at 2 weeks, 3 months, and 6 months. SETTING: Specialist outpatient physical disabilities clinic within a public pediatric teaching hospital. PARTICIPANTS: Eighty children with spastic quadriplegic, triplegic, or hemiplegic CP from these clinics were randomly assigned to BTX-A plus OT, BTX-A alone, OT alone, or a no-treatment control group. INTERVENTIONS: Single set of BTX-A (Botox) injections and 12 weeks of OT. MAIN OUTCOME MEASURES: Canadian Occupational Performance Measure (COPM) and Goal Attainment Scale (GAS). RESULTS: The combination of BTX-A and OT resulted in accelerated attainment of functional goals measured by the COPM and GAS. There were no differences between groups on the Melbourne Assessment of Unilateral Upper Limb Function, Quality of Upper Extremity Skills Test, Pediatric Evaluation of Disability Inventory, Child Health Questionnaire, or active and passive range of motion. As expected, there was a significant reduction in muscle tone at follow-up 2 weeks after injection, which returned to baseline level by 6 months. CONCLUSIONS: OT enhanced individualized functional outcomes following BTX-A injections in the upper limbs of children with CP.},
  added-at = {2014-07-19T21:53:55.000+0200},
  author = {Wallen, Margaret and O'Flaherty, Stephen J and Waugh, Mary-Clare A},
  biburl = {https://www.bibsonomy.org/bibtex/27a5de0e7ff91f5b5bf7b3ce3acf65387/ar0berts},
  doi = {10.1016/j.apmr.2006.10.017},
  groups = {public},
  interhash = {a639670dbbda9e05e72dfb55be29c403},
  intrahash = {7a5de0e7ff91f5b5bf7b3ce3acf65387},
  journal = {Arch Phys Med Rehabil},
  keywords = {Activities of Daily Living; Adolescent; Analysis Variance; Arm; Attitude to Health; Botulinum Toxin Type A; Cerebral Palsy; Child; Child, Preschool; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Injections, Intramuscular; Male; Neuromuscular Agents; Occupational Parents; Psychomotor Performance; Questionnaires; Range Motion, Articular; Single-Blind Method; Treatment Outcome},
  month = Jan,
  number = 1,
  pages = {1--10},
  pii = {S0003-9993(06)01425-0},
  pmid = {17207668},
  timestamp = {2014-07-19T21:53:55.000+0200},
  title = {Functional outcomes of intramuscular botulinum toxin type a and occupational therapy in the upper limbs of children with cerebral palsy: a randomized controlled trial.},
  url = {http://dx.doi.org/10.1016/j.apmr.2006.10.017},
  username = {ar0berts},
  volume = 88,
  year = 2007
}

@article{Wallen2004,
  abstract = {OBJECTIVE: To describe the functional and family-centered assessment protocol and outcomes of a phase II trial evaluating upper-limb function after botulinum toxin injections in children with cerebral palsy (CP). DESIGN: Intervention study, case series, phase II trial, follow-up at 2 weeks and 3 and 6 months. SETTING: Specialist outpatient physical disabilities clinic within a public pediatric teaching hospital. PARTICIPANTS: Convenience sample of 16 children with CP (age range, 2-12y). INTERVENTIONS: Botulinum toxin type A (Botox) injections after electrical stimulation localization of appropriate muscle. MAIN OUTCOME MEASURES: The Canadian Occupational Performance Measure (COPM), Goal Attainment Scale (GAS), Melbourne Assessment of Unilateral Upper Limb Function, Child Health Questionnaire (CHQ), parent questionnaire, Modified Ashworth Scale (MAS), Tardieu scale, and active (AROM) and passive (PROM) range of motion. RESULTS: On the COPM, there was significant improvement at 3 months and 6 months. On the GAS, the T-scores were 42 and 47 at 3 and 6 months, respectively. On the Melbourne Assessment and CHQ, there was no significant change. The parent questionnaire indicated acceptability of injections and positive outcomes. On the MAS, there was a significant reduction in tone at 2 weeks, with a return to baseline by 6 months. On the Tardieu scale, there was a significant increase in angle of first catch at 2 weeks, but only the elbow maintained a significant difference at 3 and 6 months. No significant change was found for AROM or PROM. CONCLUSIONS: Sustained functional outcomes occurred after botulinum toxin injections despite increasing muscle tone after an initial reduction in tone. Randomized controlled trials are required.},
  added-at = {2014-07-19T21:53:55.000+0200},
  author = {Wallen, Margaret A and O'flaherty, Stephen J and Waugh, Mary-Clare A},
  biburl = {https://www.bibsonomy.org/bibtex/215b4025a700e7654371f8f5321fc019d/ar0berts},
  groups = {public},
  interhash = {dabd6dcab7956012cf1411d26a1d591f},
  intrahash = {15b4025a700e7654371f8f5321fc019d},
  journal = {Arch Phys Med Rehabil},
  keywords = {Activities of Daily Living; Botulinum Toxin Type A; Cerebral Palsy; Child; Child, Preschool; Female; Humans; Injections, Intramuscular; Intervention Studies; Male; Muscle Weakness; Muscle, Skeletal; Neuromuscular Agents; Outcome and Process Assessment (Health Care); Parents; Questionnaires; Range Motion, Articular; Upper Extremity},
  month = Feb,
  number = 2,
  pages = {192--200},
  pii = {S0003999303009067},
  pmid = {14966702},
  timestamp = {2014-07-19T21:53:55.000+0200},
  title = {Functional outcomes of intramuscular botulinum toxin type A in the upper limbs of children with cerebral palsy: a phase II trial.},
  username = {ar0berts},
  volume = 85,
  year = 2004
}

@article{Verheyden2001,
  abstract = {Botulinum toxin A has a wide variety of clinical applications, which are related by blockade of acetylcholine and often are related to abnormal muscle contractures. These applications include ocular disorders, disorders of the upper aerodigestive tract, dystonia and hemifacial spasm, cosmetic, gastrointestinal disorders, genitourinary disorders, management of pain, and use in autonomic nervous system disorders. Many of these diseases will be discussed with regard to their treatment with botulinum toxin compared to conventional treatments. Advantages and disadvantages of botulinum toxin use are delineated. General guidelines for adult and pediatric dosing will also be discussed.},
  added-at = {2014-07-19T21:50:58.000+0200},
  author = {Verheyden, J. and Blitzer, A. and Brin, M. F.},
  biburl = {https://www.bibsonomy.org/bibtex/2e19caab24cd3c4879e39da0e2fdc946c/ar0berts},
  groups = {public},
  interhash = {d8535028e223e895322fa84e9ec587a5},
  intrahash = {e19caab24cd3c4879e39da0e2fdc946c},
  journal = {Semin Cutan Med Surg},
  keywords = {Adult; Blepharospasm; Botulinum Toxin Type A; Cerebral Palsy; Child; Humans; Neuromuscular Agents; Pain; Urinary Incontinence; Voice Disorders},
  month = Jun,
  number = 2,
  pages = {121--126},
  pmid = {11474744},
  timestamp = {2014-07-19T21:50:58.000+0200},
  title = {Other noncosmetic uses of BOTOX.},
  username = {ar0berts},
  volume = 20,
  year = 2001
}

@article{Vaile2006,
  added-at = {2014-07-19T21:50:38.000+0200},
  author = {Vaile, L. and Finlay, F.},
  biburl = {https://www.bibsonomy.org/bibtex/2b33e888c8bbfc3e1e83875f332abbf95/ar0berts},
  doi = {10.1136/adc.2005.084681},
  groups = {public},
  interhash = {049204c6941ac4844b0f9f10cff0ad9d},
  intrahash = {b33e888c8bbfc3e1e83875f332abbf95},
  journal = {Arch Dis Child},
  keywords = {Botulinum Toxin Type A; Cerebral Palsy; Child; Humans; Injections, Intralesional; Male; Neuromuscular Agents; Salivary Glands; Sialorrhea},
  month = Oct,
  number = 10,
  pages = {862--863},
  pii = {91/10/862},
  pmid = {16990361},
  timestamp = {2014-07-19T21:50:38.000+0200},
  title = {Is injection of botulinum toxin type A effective in the treatment of drooling in children with cerebral palsy?},
  url = {http://dx.doi.org/10.1136/adc.2005.084681},
  username = {ar0berts},
  volume = 91,
  year = 2006
}