Use of three-dimensional kinematic analysis following upper limb botulinum toxin A for children with hemiplegia


Anna Mackey, Department of Surgery, University of Auckland, Private Bag 92019, Auckland, New Zealand (tel.: +64 9 3737599, ext 85387; fax: +64 9 3766159; e-mail:


Background and purpose:  To examine whether three-dimensional (3-D) kinematic analysis can detect changes in upper limb tasks (reach and hand-to-mouth) in children with hemiplegia, following upper limb botulinum toxin A injections.

Methods:  Ten children with hemiplegic cerebral palsy (7 males, 3 females, aged 9–17 years). Subjects received botulinum toxin A (Botox) injections into elbow forearm muscles combined with 6 weeks of occupational therapy. Participants completed a 3-D kinematic analysis of two upper limb tasks, Melbourne Assessment of Unilateral Upper Limb Function and modified Ashworth scores measured at baseline, 2, 6 and 12 weeks post-injection.

Results:  Post-injections, elbow flexor muscle tone was reduced for 12 weeks (< 0.05). Group differences in active range of motion during 3-D analysis tasks could not be demonstrated at any time post-intervention. However, individual analyses found that at 2 weeks post-injection, three subjects had >15 degrees increases in active elbow extension and six subjects showed an increase of >25 degrees in forearm supination during performance of the reach and hand-to-mouth tasks, respectively.

Conclusions:  3-D kinematics can detect changes in active movements during functional tasks following botulinum toxin A injections, suggesting this could be a potential objective outcome measure in a clinical trial.