Children with the most severe forms of cerebral palsy (CP) are nonambulant, are unable to sit independently, and require significant assistance for daily activities (one-third of children with CP). In this randomized controlled trial, nonambulant children with CP (n = 41; mean age 7.1 years) were randomly allocated to receive either intramuscular botulinum toxin A injections (BoNT-A; n = 23) or sham procedure (n = 18) combined with therapy. Although there was no increase in moderate and severe adverse events in the children who had BoNT-A injections compared with the sham group, BoNT-A and therapy were effective for improving ease of care and comfort for nonambulant children with CP.

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