# Upper-limb range of motion in children with cerebral palsy treated with botulinum neurotoxin: a population-based cohort study

## TL;DR

This study shows that early botulinum toxin treatment in children with cerebral palsy may help maintain upper limb range of motion and prevent contractures.

## Contribution

The study provides population-based evidence that early botulinum neurotoxin-A treatment improves long-term upper limb range of motion outcomes in children with cerebral palsy.

## Key findings

- About 36% of children with cerebral palsy developed upper limb contractures before age 15.
- Early botulinum neurotoxin-A treatment (<4 years) was associated with better passive range of motion outcomes over time.
- Early monitoring of passive range of motion can detect muscle shortening before contractures develop.

## Abstract

Our aim was to investigate change over time of passive range of motion (pROM) in the upper limbs of children with cerebral palsy (CP), treated or not treated with botulinum neurotoxin-A (BoNT-A).

Data from 2000 to 2017 were collected from the Cerebral Palsy follow-up program and registry in Sweden (CPUP) for children with spastic or dyskinetic CP. Mixed models were used to analyse changes in pROM from the first, until the last measurement for five upper limb movements.

The study involved 496 children with CP, aged 1–15 years (median 2 years, Interquartile range = 4). Of these, 22% had received at least one BoNT-A treatment. Contractures were classified as red (severe) or yellow (moderate) based on the Traffic Light system within CPUP. About 36% developed upper limb contractures before age 15. Early BoNT-A treatment (< 4 years) implied better pROM outcomes over time compared with later treatment, after adjusting for pROM category, CP subtype and level of manual ability.

Upper limb contractures can develop during growth in children with CP affecting one third of this population. Early monitoring of pROM can detect the first signs of muscle shortening before contractures are established. Our findings suggest that early BoNT-A treatment may help maintain pROM in children with CP.

The online version contains supplementary material available at 10.1186/s12891-026-09528-z.