الفهرس 
DEFINITION, CAUSES AND CLASSIFICATIONS OF CEREBRAL PALSYOnly 14 pages are availabe for public view
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Abstract
C
erebral palsy is group of disorders that affect muscle movement and coordination. It is due to damage to the developing brain either during pregnancy or shortly after birth.
BTX-A become a popular treatment option in children with spastic paresis in aim to reduce the tone of spastic muscles, improve the motor function of the injected limb, prevention of permanent joint contractures, posture correction, better cosmetic appearance and delay the option of surgical intervention.
Although, the BTX-A can be injected in muscles of upper limb, lower limb and spine, in our study we focused on the effect of its injection to upper limbs in spastic unilateral and bilateral cerebral palsy cases.
The aims of injection of BTX-A to upper limbs in cases of spastic cerebral palsy are reduction of spasticity, prevention of permanent muscle contractures and improving the function of the injected upper limb that will reflect on the quality of life of the children and their caregivers, the degree of dependence of the child to make the activity of daily living and to improve the bimanual hand function that is essential in school age child activity as writing, drawing, etc.
The BTX-A injection has precautions to reach the best results with less complications. These precautions should be followed with the children that will be recruited for injection as they have accepted cognitive level, mild to moderate degree of spasticity and they don’t have a permanent muscle contracture. Adequate muscle localization before injection by anatomical land marks, electric stimulation and /or ultrasound imaging. Usage of a suitable type of anesthesia to overcome the painful sensation of BTX-A injection and appropriate calculation of the appropriate dose
There are many adjunctive treatment regimens that can be done before/ after injection of BTX-A to magnify and prolong the effect of its injection on the affected upper limb as occupational therapy, bimanual task oriented therapy, regular physiotherapy program or orthotics.
The assessment of the effect of BTX-A injection should done by a validated and approved scale and the same scale should be used before and after the intervention for proper evaluation of the outcome after BTX-A injection. These assessment scale may assess the degree of spasticity, muscle tone, quality of upper limb function, degree of caregiver assistance, etc.
Altogether 420 articles were found using the reported search, of which 15 presented the best evidence to answer the clinical question.
The author, year of publication, number, mean age, randomization of the included participants (intervention and control groups), the type of BTX-A used in each study, dose of BTX-A and time of follow up before and after the intervention were tabulated. The information about the journals of publication, number of injection sessions, method of muscle localization, type of anaesethia used before injection, the scales used for assessment of the participants before and after the injection and complications of BTX-A injection that reported in the eligible studies were also detailed.