18ResultsImplicationsEmergent themes included perceptions of benefits of hydrotherapy, outcomes, barriers andpool accessibility issues.• Parents perceived greater benefits of hydrotherapy, and valued their and their child’sinvolvement more than therapists did.• Parents perceived the benefits <strong>to</strong> be ‘increase in muscle strength’ and ‘improvements inland-based gross mo<strong>to</strong>r skills’.• In contrast, therapists talked about the social benefits for the child and parent attendingthe group, particularly in relation <strong>to</strong> parent networking.• The barriers identified by therapists were location and temperature of the pool, difficultieswith travel and parents unable <strong>to</strong> fit it in the day.• Parents commented that fitting it in with other siblings, kindergarten/school and sleeptimes were more of an issue than travel.For clients – clients value hydrotherapy highly and consider it a fundamental and essentialcomponent of their child’s therapy.For services –this study has prompted a review of the hydrotherapy services provided at<strong>Novita</strong>, including how <strong>to</strong> best address the barriers identified by families and the role/need fortraining in multidisciplinary input in hydrotherapy services.There is a need for more rigorous clinical studies examining the effects of hydrotherapy forchildren with physical and/or multiple disabilities.StatusCompletedProject titleContribu<strong>to</strong>rsFundingSummaryBotulinum <strong>to</strong>xin and the neglected upper limb in children with hemiplegic cerebralpalsyDr Ray Russo (Children, Youth, and Women’s Health Service), Professor Maria Crotty(Flinders University), Dr Michelle Miller (Flinders University), Sonya Murchland, Dr PeterFlett (Calvary Health Care, Tasmania), Dr Eric Haan (Children, Youth, and Women’s HealthService), Belinda Van Zelst (Flinders University)• Allergan Pharmaceutical Company• Financial Markets Foundation for ChildrenThis project was a population-based study of children with hemiplegic cerebral palsyidentified from the South Australian Cerebral Palsy Register. The first phase of the studywas evaluating the children’s level of impairment, and functional abilities, while the secondphase was <strong>to</strong> assess the effect of botulinum <strong>to</strong>xin A (BoNT-A) and occupational therapy (OT)compared with occupational therapy alone on body structure, activities participation and selfperceptionin a sample of children recruited through the first phase of the study.
19MethodPhase 1: children were recruited and under<strong>to</strong>ok baseline assessment of their neurologicalfunctioning, <strong>to</strong>ne in upper limb, self-perception and activity participation in activities of dailyliving using the Assessment of Mo<strong>to</strong>r and Process Skills.Phase 2: Children from Phase 1 aged three <strong>to</strong> 16 years who met the criteria of a diagnosis ofhemiplegia, passive joint range of motion within defined limits, ability <strong>to</strong> initiate movement ofthe fingers, a Modified Ashworth Scale (MAS) of greater or equal <strong>to</strong> two on four at the elbowor wrist became the participants. They were ineligible if they had received BoNT-A in theupper limb less than one year previously, or the lower limb less than six months before thestudy.The children were randomly assigned in blocks of 10 <strong>to</strong> either OT only or OT and BoNT-Aintervention pro<strong>to</strong>cols. All children received a four week block of OT, which commencedwithin two weeks of injection for those children that received BoNT-A. All participants wereassessed at baseline, then at three and six months post-intervention. Measures included;neurological assessment, MAS, Tardieu Scale, subjective report on perception if they were‘worse’, ‘the same’ or ‘better’ since the intervention (in terms of cosmesis and function), PEDI,PedsQOL, Self-Perception Profile for Children, Pic<strong>to</strong>rial Scale of Perceived Competence andSocial Acceptance, Assessment of Mo<strong>to</strong>r and Process Skills, Goal Attainment Scaling (GAS),and Pain via visual analogue scale.ResultsPhase 1: 54 of the 77 children with hemiplegia identified through the SACPR were recruitedand consented <strong>to</strong> the study. They had a mean age of seven years four months (SD 2year 5 m), 33 (61%) had right hemiplegia and 37 (69%) lived within 100km of Adelaide. Allparticipants were found <strong>to</strong> have significant difficulties with mo<strong>to</strong>r and process skills that wouldhave an impact on their ability in daily living tasks. More difficulty was found in mo<strong>to</strong>r skills inolder children (nine <strong>to</strong> 12 years) than younger children (three <strong>to</strong> eight years), and process skilldeficits may have more impact on development of independence than expected.Phase 2: 43 children (84%) were identified as being eligible and 51 (47%) of the 108 childrenassessed consented <strong>to</strong> participate and were randomly assigned <strong>to</strong> either group. At baselinethere were similarities in function, demographic and quality of life characteristics. Significantimprovement was found in the BoNT-A and OT group at three and six months in bodystructure, as well as improvements in activity participation, GAS, and Global Self-Worth atthree months. By six months there was no difference in the activity participation measuresbetween groups. The BoNT-A and OT group also experienced an increase in self-worth,which decreased in the OT only group.ImplicationsFor clients – BoNT-A can have a significant impact on children’s abilities across all levels ofperformance with improved self-worth.For services – OT is an important adjunct <strong>to</strong> BoNT-A injection <strong>to</strong> maximise outcomes forchildren with hemiplegia. OT input alone can also have a positive and lasting impact onchildren’s activity participation.StatusCompleted