UL Botulinum toxin-A

This two-session online training course is designed for clinicians working with children with neurological impairment, focusing on the rationale for using Botulinum toxin-A (BoNT-A) as an adjunct to upper limb rehabilitation. Drawing on the latest scientific evidence alongside 25+ years of clinical experience in upper limb BoNT-A use, this theoretical and practical course will help clinicians determine who, when and why to consider BoNT-A as part of evidence-based upper limb intervention.

Session 1 covers what BoNT-A is, how it works and how it is administered; the evidence and safety data for upper limb BoNT-A in children with CP; how upper limb contractures develop; concepts and definitions for muscle overactivity; assessment for upper limb injection; and deciding which children to treat and when, based on goals for function or symptom management.

Session 2 covers applied upper limb anatomy and muscle selection (which muscle, why and when), and other impairment-based interventions including static night thermoplastic wrist/hand orthoses, dynamic splinting, casting and functional electrical stimulation (FES).

A course manual and electronic copies of the course references are provided.

Who should attend

Occupational therapists, physiotherapists and physicians involved in the assessment and management of upper limb muscle overactivity in children with neurological impairment.

Course objectives

On completion of this course, participants will be able to:

1. Define the current concepts and terminology for muscle overactivity in children with upper motor neurone disorders.

2. Explain the mechanism of effect, administration, safety data and possible adverse events of upper limb BoNT-A injection in children.

3. Describe how upper limb contractures develop in children with cerebral palsy and the role of the therapist in upper limb spasticity management.

4. Assess a child with upper limb muscle overactivity to determine whether they may benefit from BoNT-A, and distinguish the aims of injection for function from those for symptom management.

5. Justify which upper limb muscles to recommend for BoNT-A injection, and when, based on applied anatomy and assessment findings.

6. Distinguish children who are likely to benefit from BoNT-A from those better suited to other impairment-based interventions such as orthoses, casting or functional electrical stimulation.

7. Plan evidence-based upper limb intervention following BoNT-A injection and select outcome measures to evaluate it.

Course requirements

Before the course, participants are asked to read the three pre-course papers provided on the CPTeaching Learning Management System (LMS) and download the course manual.

Prerequisites: Nil.

Attendance at both online sessions is required to receive the attendance certificate.