The aim of this study was to investigate upper limb botulinum toxin A (BTX-A) injections in children with spastic hemiplegia.

Ten children with hemiplegia, aged 10–17 years, received upper limb BTX-A injections and 6 weeks therapy. BTX-A was injected using EMG guidance into elbow and wrist flexors, and forearm pronators (dose 1–2 units/kg body wt (Botox®) per muscle). Follow-up assessments continued to 24 weeks post BTX-A. Outcome measures included three-dimensional (3-D) upper limb analysis of functional tasks, Melbourne Assessment; passive range of motion (PROM), and muscle tone.

There were no serious adverse effects. Elbow flexor muscle tone was reduced to 12 weeks post BTX-A (p < 0.05). Mean passive elbow supination increased by 19 degrees (not significant, p= 0.3). Pre-injection 3-D analysis showed that, compared to controls, children with hemiplegia were slower at performing upper limb reaching tasks, using less elbow extension and supination, and utilising increased compensatory trunk forward flexion. Post BTX-A, the time to complete upper limb tasks did not change (p> 0.15). However, at least six subjects had increased elbow extension (average 17 degrees) and decreased trunk forward flexion (average 16 degrees) during upper limb reaching tasks. Five subjects improved their Melbourne Assessment score by 5% or greater.

Decreased tone and individual improvements in upper limb functional tasks were seen post BTX-A and therapy. However deficits in timing of upper limb movements did not change post BTX-A.

Recent years have seen a decided swing from the longstanding inpatient model of rehabilitation to an outpatient model for all branches of medicine in Australia. This swing has been largely cost-driven and is unlikely to change.

This paper reports on the development of a Paediatric Spinal Outreach Team (ORT) in New South Wales (NSW). The ORT was formed in 1993 and consists of a nurse, physiotherapist, occupational therapist and a social worker. It functions in close collaboration with the two children’s hospitals in Sydney. Approximately 10–11 new cases of paraplegia/quadriplegia occur in children/adolescents (up to 18 years of age) in NSW each year (population approx. 6 million). Their therapeutic needs change with growth, development and maturation. Families in regional NSW have special requirements and web-site information services (distance education) will play an important role for them in the future. Integration with an organisation which provides ancillary services is essential for a comprehensive, state-wide programme.

It is suggested that a comparable service would play an equally important role in other countries. Case studies to demonstrate savings to be made with this type of service need to be done to secure recurrent government funding.

Recent years have seen a decided swing from the longstanding inpatient model of rehabilitation to an outpatient model for all branches of medicine in Australia. This swing has been largely cost-driven and is unlikely to change. This paper reports on the development of a paediatric spinal outreach team (ORT) in NSW. The ORT was formed in 1993 and consists of a nurse, physiotherapist, occupational therapist and a social worker. It functions in close collaboration with the two children’s hospitals in Sydney. Approximately 10–11 new cases of paraplegia/quadriplegia occur in children/adolescents (up to 18 years of age) in NSW each year. Their therapeutic needs change with growth, development and maturation. Families in regional NSW have special requirements and website information services (distance education) will play an important role for them in the future. Integration with an organisation which provides ancillary services is essential for a comprehensive, state-wide program.

It is suggested that a comparable service would play an equally important role in other states. Case studies to demonstrate savings to be made with this type of service need to be done to secure recurrent government funding.

Recent years have seen a decided swing from the longstanding inpatient model of rehabilitation to an outpatient model for all branches of medicine in Australia. This swing has been largely cost-driven and is unlikely to change. This paper reports on the development of a paediatric spinal outreach team (ORT) in NSW. The ORT was formed in 1993 and consists of a nurse, physiotherapist, occupational therapist and a social worker. It functions in close collaboration with the two children’s hospitals in Sydney. Approximately 10–11 new cases of paraplegia/quadriplegia occur in children/adolescents (up to 18 years of age) in NSW each year. Their therapeutic needs change with growth, development and maturation. Families in regional NSW have special requirements and website information services (distance education) will play an important role for them in the future. Integration with an organisation which provides ancillary services is essential for a comprehensive, statewide program.

It is suggested that a comparable service would play an equally important role in other states. Case studies to demonstrate savings to be made with this type of service need to be done to secure recurrent government funding.

Recent years have seen a decided swing from the longstanding inpatient model of rehabilitation to an outpatient model for all branches of medicine in Australia. This swing has been largely cost-driven and is unlikely to change. This paper reports on the development of a paediatric spinal outreach team (ORT) in NSW. The ORT was formed in 1993 and consists of a nurse, physiotherapist, occupational therapist and a social worker. It functions in close collaboration with the two children’s hospitals in Sydney. Approximately 10–11 new cases of paraplegia/quadriplegia occur in children/adolescents (up to 18 years of age) in NSW each year. Their therapeutic needs change with growth, development and maturation. Families in regional NSW have special requirements and website information services (distance education) will play an important role for them in the future. Integration with an organisation which provides ancillary services is essential for a comprehensive, statewide program.

It is suggested that a comparable service would play an equally important role in other states. Case studies to demonstrate savings to be made with this type of service need to be done to secure recurrent government funding.