Table 2.

Presentation of articles according to the objectives, intervention methods, conclusion with PEDro scoring.

Authors (year)	Objective	Intervention	Results	Conclusion	PEDro Score
Williams et al. (2013)	Effects of strength training and Botulinum Toxin Type-A (BoNT-A) in children with Cerebral Palsy on muscular strength and morphology	Participants performed a 10-week home-based strength training programme that included three sessions per week. Manual and passive stretching of the lower limb muscle groups were incorporated in each training session. Progressive strengthening exercises were given with repetitions and loading levels as the child’s strength increased.	Spasticity was reduced significantly (p = 0.033) post BoNT-A injection. In the intervention phase, children improved their isokinetic strength significantly (mean p = 0.022, ES = 0.57) compared to the control period (mean p = 0.15, ES = 0.56)	Treatment with BoNT-A alone, the combination of BoNT-A and strength training was effective in reducing spasticity, enhancing strength, and reaching functional goals	8/10
Elvrum et al. (2013)	To investigate effects of additional resistance training on the upper limbs in children with CP after using Botulinum Toxin-A (BoNT-A)	BoNT-A injections in the pronator teres were given to all individuals in Groups B (BONT-A therapy) and BT (BONT-A injection with eight-week resistance training). BoNT-A injections in biceps brachii and brachialis were also given to three subjects in Group B and two in group BT	Short-term treatment benefits in favorgroup BT for muscular strength in injected muscles (elbow flexor strength, p = 0.08) and non-injected regions (elbow extension and supination strength, both p = 0.05) were significant or near to significant,. Both groups improved their active supination range, but group BT improved more (p = 0.09)	Without increasing muscular tone, resistance training temporarily strengthens non-injected muscles and may decrease short-term strength loss caused by BoNT-A injections	6/10
Hoare et al. (2013)	Examine the effects of modified mCIMT with a carefully specified, standard BOT programme on bimanual upper limb performance in young children with unilateral CP after upper limb injections of BoNT-A	BoNT-A and mCIMT to the experimental group (n = 17). BoNT-A and BOT were given to the comparison group (n = 17)	BONT-A + mCIMT: EMD 2.7, 95% confidence interval 0.7-5.2; BONT-A + BOT: Estimated mean difference 95% confidence interval 2.1–8.6) showed improvement with time	In young children with unilateral CP, there was no evidence that mCIMT was superior than a structured BOT programme in terms of bimanual upper limb performance, functional skills, occupational performance, or goal attainment outcomes after injection of BoNT-A	8/10
Lidman et al. (2015)	In children with unilateral spastic cerebral palsy, the effects of repeated botulinum toxin A (BoNT-A) injections combined with occupational therapy, including a splint, were compared to the effects of occupational therapy alone on hand function in all international classifications of functioning, disability, and health domains	Both groups got two 8-week therapy blocks that included the establishment of a home programme as well as a weekly consultation with an occupational therapist. Manual stretch (once a day) and the use of a static circular splint were used in conjunction with bimanual training (56 hours in 8 weeks) of repeated task practise and goal-directed exercises (8 h per night). The splint was created with the elbow flexed, the forearm in supination, and the thumb in radial and volar abduction on an individual basis	At 12 months, the BoNT-A/OT group had a better effect on hand assessment: 6 out of 10 in the occupational therapy group improved, compared to 1 out of 10 in the control group (p < 0.03)	In young children with unilateral spastic CP, repeated BoNT-A/OT proved to be superior to occupational therapy alone for bimanual performance. Both groups improved their active ROM and goal performance	7/10
Speth et al. (2015)	Effects of botulinum toxin Injections in the upper extremity along with bimanual task-oriented therapy or each treatment method administered independently in children with unilateral Cerebral Palsy	For 12 weeks, the Bimanual task focused therapy programme comprised of half an hour of physiotherapy (PT) and one hour of occupational therapy (OT). Two times a week, children in the outpatient clinic got PT and OT (12 hours) following each other	The quality scores,posture during grasping and holding, notably in the younger children, improved significantly in the BoNT-A group. At 12 and 24 weeks, the BITT group improved greatly on the AK and much more on the COPM’s performance and satisfaction scores on various goals	During the three months of work, BoNT-A has a beneficial influence on the quality of mobility and amount of use of the affected upper extrimity. Bimanual performance and achievement of goals are unaffected by BoNT-A	6/10
Desloovere et al. (2012)	To compare the effects of various physiotherapeutic programmes in children with Cerebral Palsy after treatment with BTX-A.	First group received BTX-A on multiple levels, followed by NDT Second group - Multilevel BTX-A injections, followed by conventional physiotherapy (muscle strengthening, stretching,). All patients got multilevel BoNT	Overall treatment efficacy was attained in 76 % of the targets in the NDT group, compared to 67 % in the conventional physiotherapy group	The short-term benefits of a NDT approach are more evident in a post-BTX-A regimen than those of a traditional physiotherapy technique	6/10
Park et al. (2009)	To see if using modified constraint-induced movement therapy (mCIMT) after a BoNT-A toxin (BoNT-A) injection in the spastic upper extremity of children having hemiplegic cerebral palsy improves the effects of the BoNT-A injection	Group A - BoNT-A and mCIMT Group B - BoNT-A injections	Both groups showed significant improvements in muscle tone and movement patterns (p < 0.05)	In children with hemiplegic CP, combined mCIMT and BoNT-A therapy generally improves the effect of the BoNT-A injection in the functional use of the affected limb	5/10
Kaishou et al. (2009)	To compare the effectiveness of different types of botulinum toxin to treat ankle plantar flexor spasticity, an injection guided by several localising techniques, electrical stimulation, and palpation is used	Group A - Botulinum toxin A injection group guided by electrical stimulation plus physiotherapy Group B - Botulinum toxin A injection group guided by palpation plus physiotherapy Group C - Physiotherapy	Three groups showed a substantial improvement (p < 0.05). In the botulinum toxin group guided by electrical stimulation injection plus physiotherapy, the mean improvements between baseline and the end of follow-up were respectively 20, 16.2 and 11.9 degrees for passive ROM, 1.9, 1.4 and 0.7 for modified Ashworth Scale scores, 5.8, 4.2 and 2.3 for Composite Spasticity Scale scores, 18.6, 11.3 and 6.9 for Gross Motor Function Measure scores, and 0.2, 0.1 and 0.1 m/s for walking velocity	In children with cerebral palsy, botulinum toxin injections combined with electrical stimulation and physiotherapy are most likely to improve spasticity and functional performance	7/10
Thomas et al. (2016)	The goal of this study was to compare the efficacy of groupindividual physiotherapy rehabilitation for ambulant children with cerebral palsy after lower limb intramuscular injections of Botulinum Toxin-Type A (BoNT-A)	Total treatment time (six hours, six weekly 60-minute sessions). The only difference between the two groups was the therapeutic delivery technique. Both groups got the same direct dosage and content of the treatment based on the groups and individual groups	Both groups showed clinically major improvements in COPM performance, but only a slight improvement in gait quality (EVGS). Following lower limb BoNT-A injections, six hours of direct physiotherapy were combined with an additional indirect dose (median 16 episodes) of personalised home programme exercises	After lower limb injections of BoNT-A, this pragmatic randomised comparative trial demonstrated no clinically relevant changes in any primary or secondary outcomes between group and individually provided physiotherapy	8/10