Fasoli SE, Fragala-Pinkham M, Hughes R, Krebs HI, Hogan N, Stein J: Robotic therapy and botulinum toxin type A: a novel intervention approach for cerebral palsy. Am J Phys Med Rehabil 2008;87:1022-1025.
The combined effects of robotic therapy and botulinum toxin type A (BTX-A) on upper-limb movement and function were studied in an 8½-yr-old child with hemiplegic cerebral palsy. Robotic therapy comprising repetitive, goal-directed reaching tasks was administered two times per week for 8 wks. Clinical measures included the Modified Ashworth Scale, the Quality of Upper Extremity Skills Test, and the Fugl-Meyer Assessment (upper-limb section). Improvements in upper-limb coordination and quality of motor performance were apparent throughout the robotic therapy trial. The observed gains are comparable with those attained from conventional occupational therapy combined with BTX-A. A parent questionnaire indicated that the amount of paretic arm use also improved during daily activities at home. This preliminary study indicates that robotic therapy may be a useful clinical tool when combined with BTX-A injections for improving upper-limb coordination and quality of motor performance in children with cerebral palsy.