Effectiveness of upper extremity BoNT-A Treatment followed by rehabilitation approaches on activity and participation in children with cerebral palsy: A systematic review

Purpose: This study aimed to investigate the effect of interventions applied in addition to Botulinum Toxin Type A (BoNT-A) application to the upper extremities on activity and participation in children with Cerebral Palsy (CP). Materials and methods: A systematic review was performed using the American Academy of Cerebral Palsy and Developmental Medicine Methodology. The PubMed, PEDro, ScienceDirect, Web of Science, and Cochrane Library databases were searched. All the included articles were evaluated based on their level of evidence and conduct. Results: Six articles met the inclusion criteria and included children and adolescents with CP. Studies have examined the effectiveness of different approaches, and some studies have found that the intervention applied is effective for activities or participation. Conclusions: It was concluded that BoNT-A followed by upper limb rehabilitation approaches is effective in improving activity and participation levels of the International Classification of Functioning, Disability, and Health (ICF). However, the superiority of combining BoNT-A with rehabilitation programs over rehabilitation programs alone remains inconclusive. Therefore, further clinical trials are needed to determine the efficacy of combining BoNT-A with a rehabilitation program to improve ICF parameters.