The effect of botulinum toxin type A treatment of the lower extremity on the level of functional abilities in children with cerebral palsy: evaluation with goal attainment scaling

Objective: To measure the effect of botulinum toxin type A ( BTX- A) treatment in children with cerebral palsy with regard to individual goals concerning functional abilities, using goal attainment scaling. Design: A single- blind randomized multiple baseline/ treatment phase design across subjects. Setting: The paediatric department of a rehabilitation centre. Subjects: Eleven children with cerebral palsy participated. Intervention: BTX- A treatment of the lower extremity. Main measures: A six- point goal attainment scaling of three individual treatment goals at the level of functional abilities. Standardized video- tapes of each goal were recorded weekly for a period of 14 weeks. Rating on the predetermined goal attainment scaling was blinded. Results: Nine of the 11 subjects showed significant improvement in 18 out of 33 goals. Seven subjects showed clinically relevant improvement ( at least 2 points on the goal attainment scaling) in 11 goals. Testing the difference between all medians of baseline measurements ( after correction for improvement during baseline) and the medians of the treatment phase measurements for all goal attainment scaling scores ( n = 33) resulted in significant improvement ( p < 0.001). Tested at subject level ( medians of the three goal attainment scaling scores per assessment, n = 11), a significant improvement was also found ( p = 0.005). The change in goal attainment scaling score was related to the moment of treatment with BTX- A. Conclusion: Clinically relevant improvement in individual rehabilitation goals at ability level, achieved with the treatment of BTX- A in children with cerebral palsy, were demonstrated using the goal attainment scaling method.