108 Using a holistic framework to review the impact of lower limb botulinum toxin a treatment on ambulant children with cerebral palsy
Bibliographic record
Abstract
Background Botulinum toxin (BoNT-A) is an accepted treatment for increased muscle tone in children and young people with cerebral palsy (CP). It is used in conjunction with occupational and physiotherapy to promote improved motor ability. However, treating the impairment does not automatically increase participation in activities important to children and families. The F-words model sets the International Classification of Functioning, Disability and Health in a child-development context. It provides holistic assessment and directs intervention towards meaningful participation i.e. involvement in a real-life situation. This prospective single site study evaluated goal setting in ambulant children and young people with CP undergoing BoNT-A injections using the Canadian Occupational Performance Measure (COPM). Method 64 CYPwCP participated in the study. Children and families were invited to set goals for their BoNT-A and rehabilitation, scoring baseline COPM performance and satisfaction for each goal. These goals were analysed using the F-words framework by the principal investigator (LK) and two independent reviewers. Results F-words analysis of 169 goals showed 33% in the Fitness category, addressing pain, fatigue, splint tolerance, aesthetics, range, movement selectivity, power, balance, and posture; 57% in Function, predominantly walking related and seven activities of daily living (dressing, toileting); 10% in Fun - leisure activities; 1 goal in Friends (keeping up with peers). Discussion In this study goal setting was inclusive (family identified) and allowed families to evaluate performance and satisfaction providing an objective measure of goal-outcome following BoNT-A. There was a tendency to concentrate on areas of Fitness and Function, rather than goals in meaningful contexts that reflected participation (Fun and Friends). For example, 80 goals referenced walking but only one had context – ‘in the playground’ - improving participation with friends. Asking families why they have identified their goals, and what improvements mean in their daily lives could help direct a participation narrative.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.007 | 0.030 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.015 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 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".