36 Evaluating the effect of lower limb botulinum toxin a injections on goal-directed outcomes in ambulant children and young people with cerebral palsy
Bibliographic record
Abstract
Background Botulinum toxin-A (BoNT-A) is used in management of hypertonia in children and young people with cerebral palsy (CYPwCP). Evidence is limited regarding its effect on goal-directed outcome measures. Meaningful child-and-family-centred goal identification is an essential element of rehabilitation, ensuring interventions are targeted towards children’s individual priorities. This prospective single site study assessed goal attainment in CYPwCP undergoing BoNT-A injections using the Canadian Occupational Performance Measure (COPM). Methods Data were collected from 64 ambulant CYPwCP (Gross Motor Function Classification System levels I-III) aged 4 to 16 years undergoing lower limb BoNT-A injections within the movement disorder service at GOSH. Changes in COPM scores were analysed at 6-weeks, 6-months and 12-months post-intervention using Friedman tests. Participants’ goals were classified according to the International Classification of Functioning, Disability and Health domains of Body Structure and Function, Activity and Participation and Environmental Factors. Results COPM performance scores improved significantly from baseline to 6-weeks (median difference 3.17; p-value <0.001) and 6-months (median difference 2; p-value <0.001) and 12-months post-intervention (median difference 2.7; p-value <0.01). COPM satisfaction scores showed a similar pattern. Of 169 individual goals selected, 57.4% related to Activities and Participation, 37.3% related to Body Structures and Functions and 5.3% related to Environmental Factors. Activity and Participation goals demonstrated the most sustained positive response to BoNT-A injections over time. Conclusions BoNT-A injections were associated with improved COPM scores at all post-injection time-points. The results suggested that goal achievement in Activity and Participation domains of the ICF showed more stability than those in Body-Structure-Function or Environment domains. Recommendations Further longitudinal studies evaluating COPM scores are required, particularly those evaluating change with re-injection frequency and additional outcome measures. Detailed investigation of the responsiveness of goals throughout the domains of Activity and Participation would also help improve the accuracy of predicting response to BoNT- A injections.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".