300 Section - The Efficacy of Low Dose Botulinum Toxin Type A vs Hand Splint in Spastic Cerebral Palsy Children with Thumb in Palm Deformity: A Randomized Controlled Trial

Objectives : To compare efficacy between Low dose of Botulinum toxin type A and hand splint on Hand function, Spasticity, Range of motion

Design: A randomized, assessor-blinded controlled trial was conducted with 27 participants, who were evenly allocated into three groups (n = 9/ group). Group 1 received low-dose Botulinum toxin type A injections combined with conventional occupational therapy (BoNT-A + OT), Group 2 received a hand splint combined with conventional occupational therapy (Hand Splint + OT), and Group 3 received conventional occupational therapy alone (OT only). All participants also received a home-based OT program. Baseline characteristics were documented, and outcomes were assessed at three time points—pre-treatment, 4 weeks, and 12 weeks—using the Quality of Upper Extremity Skills Test (QUEST) grasp domain, Modified Ashworth Scale (MAS), and range of motion of wrist and finger.

Results: The BoNT-A + OT group showed significant improvements at both 4 and 12 weeks, QUEST-Grasp score (p < 0.001,p = 0.004) and MAS (p = 0.013,p = 0.003). Compared with OT only group, BoNT-A + OT group demonstrated significantly greater improvements at week 4 in both QUEST-Grasp scores and MAS (p = 0.028, p = 0.007). Hand Splint + OT group showed significant improvement in QUEST-Grasp score at week 12 (p = 0.001) and MAS at both week 4 and 12 (p = 0.003 for both). OT only group exhibited significant improvement of QUEST-Grasp score at week 12 (p = 0.004). However, by week 12, no statistically significant differences demonstrated among three groups in all outcome measures.

Conclusion: Low-dose Botulinum toxin type A injections combined with OT provides the most effective treatment at week 4, particularly in improving hand function and reducing spasticity in children with spastic cerebral palsy and thumb-in-palm deformity. Nevertheless, home-based OT program remains an essential care for all patients.