Optimizing Use of Botulinum Toxin Type A for Pediatric Upper Limb Spasticity: Transforming Science Into Clinical Success

Release Date: August 31, 2020 
Last Reviewed: August 31, 2020
Expiration Date: August 31, 2021
Time to Complete Activity: 1.0 hour

*This activity expired for credit on August 31, 2021 and is no longer available for credit

Katharine Alter, MD

Prince George’s Hospital Center
Cheverly, MD

Jahannaz Dastgir, DO
Pediatric Neuromuscular Medicine Program
Division of Child Neurology
Goryeb Children’s Hospital
Morristown, NJ

Sherry A. Downie, PhD
Albert Einstein College of Medicine
Bronx, NY
This activity is provided by Paradigm Medical Communications, LLC.   

Target Audience
This activity has been designed to address the educational needs of neurologists, physical medicine and rehabilitation physicians (also known as physiatrists), developmental pediatricians, and orthopedic surgeons. It may also be of benefit to other healthcare providers who are involved in the management of spasticity, including pediatric nurse practitioners and PAs.

Statement of Need
Spasticity is a prevalent disabling consequence of cerebral palsy, the most common motor disability in childhood. Other causes of spasticity in children include traumatic brain injury, multiple sclerosis, spinal cord injury, and stroke. Spasticity can prevent or hamper function, cause pain, disturb sleep, cause unnecessary complications, and present major difficulties for caregivers. Managing upper limb spasticity (ULS) is complex and a major challenge in the rehabilitation of these children. Although treatment with botulinum neurotoxin type A (BoNT-A) is an effective, established first-line adjuvant therapy to physical rehabilitation for the management of spasticity in children, there is considerable variation of its use in practice, without clear standards for providers, leading to variable outcomes. This activity is designed to educate clinicians about the differentiating characteristics of available agents, as well as their optimal use in pediatric ULS, including current methods for ensuring accurate delivery of BoNT-A to the appropriate target muscles.

Learning Objectives
Upon proper completion of this activity, participants should be better able to:
  • Evaluate available BoNT-As, including their mechanisms of action, indications, and preparation, as well as their dosing, efficacy, and safety, in pediatric ULS.
  • Identify the anatomy and pathophysiology of musculature associated with pediatric ULS in which BoNT-As have proven effective in reducing symptoms.
  • Describe current methods for ensuring accurate delivery of BoNT-As to the appropriate target muscles for pediatric ULS.
Physician Accreditation Statement
Paradigm Medical Communications, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Physician Credit Designation Statement
Paradigm Medical Communications, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

PA Continuing Education
PAs may claim a maximum of 1.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society.

Nurse Practitioner Continuing Education
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. Individuals are responsible for checking with the AANPCP for further guidelines.

Disclosure of Commercial Support
This activity is supported by an educational grant from Allergan, Inc.

Instructions for Participation 
To receive a CME certificate of participation, you should:
  • Follow instructions to register or log in with your professional information and complete the pre-activity assessment
  • View the online activity in its entirety. 
  • Complete and submit the online posttest and evaluation. You must answer 70% of the posttest questions correctly to earn credit. You will have unlimited opportunities to successfully complete the posttest.
A certificate of participation will be available for download/printing immediately following your successful completion of the posttest and evaluation.

For questions regarding CME credit, contact the Paradigm CME Department at (845) 398-5949.

There is no fee required for participation in this activity.

Hardware/Software Requirements
This certified CME activity is designed using HTML5 web components. As you navigate the video using the supplied controls, the slides will sync to the speaker.

Supported Browsers (Desktop/Mobile)
Chrome 45+, Firefox 40+, Edge, Edge Chromium, Safari 8+, Opera 31+

PDF documents
This activity may contain PDF documents. Most current browsers support viewing of PDFs natively, but you may also download a free version of Adobe Acrobat Reader here: http://get.adobe.com/reader 

Technical Support
If you have any technical problems or playback issues email us at contactus@paradigmmc.com.

In accordance with ACCME requirements on disclosure, faculty and contributors are asked to disclose any relationships with commercial interests associated with the area of medicine featured in the activity. These relationships are described below.

Katharine Alter, MD
Royalty: Demos Medical Publishing

Jahannaz Dastgir, DO
No financial relationships to disclose.

Sherry A. Downie, PhD
Consulting Fees: Allergan, Inc.
Speakers Bureau: Allergan, Inc.

Paradigm Medical Communications, LLC staff members have no financial relationships to disclose.

Independent peer reviewer, Stephen Nichols, MD, has the following financial relationships to disclose:
Grant/Research Support: Ipsen Biopharmaceuticals, Inc.

Resolution of Conflict of Interest
Paradigm Medical Communications, LLC has implemented a system to resolve conflicts of interest for each CME activity to help ensure content is objective, fair and balanced, independent, and aligned with the public interest. Conflicts, if any, are resolved through one or more processes. All CME content in this activity was independently reviewed to ensure that it is free of commercial bias, scientifically rigorous, aligned with the public interest, and compliant with all regulatory guidance and the ACCME’s Standards for Commercial Support of Continuing Medical Education.

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not approved by the FDA.

This CME activity represents the views and opinions of the individual faculty, and does not constitute the opinion or endorsement of, or promotion by, Paradigm Medical Communications, LLC. Reasonable efforts have been taken to present educational subject matter in a balanced, unbiased fashion, and in compliance with regulatory requirements. However, each activity participant must always use his or her own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions including, without limitation, FDA-approved uses and any off-label uses.

If included, signed statements of informed consent granting permission for publication have been obtained for all photographs and videos in which an individual can be identified.

As an ACCME-accredited provider, Paradigm Medical Communications, LLC activities must include a balanced view of therapeutic options. Use of generic names contributes to this impartiality. In this activity, the trade names for neuromodulators are used for clarity. The use of trade names should not be viewed as an endorsement of specific products by Paradigm Medical Communications, LLC. 

Terms of Use and Privacy Policy
The materials provided for this activity are for informational purposes only, and should not be used for diagnosis or treatment of a health problem without consulting a licensed medical professional. This CME activity represents the views and opinions of the individual faculty, and does not constitute the opinion or endorsement of, or promotion by, Paradigm Medical Communications, LLC. References to any entity, product, service, or source of information on this website should not be considered an endorsement, either direct or implied, by Paradigm Medical Communications, LLC. Paradigm Medical Communications, LLC accepts no liability for the content referenced in this activity.

Privacy policy
Paradigm Medical Communications, LLC or hosted contracted partner is committed to protecting the privacy of those who participate in the activities located at www.paradigmmc.com (herein referred to as “website"). The information below describes the security of the website for safeguarding personal information and the rationale for collection and use of personal information.

Security/safeguarding personal information
This website has physical and procedural safeguards in place to prevent unauthorized access to personal information used to access this website.

Collection and use of your personal information
The submission of certain personally identifiable information is necessary to award and track the credits participants may earn after completing the program. Required items include first name, last name, degree, and email address. These items are necessary. Participants are also required to complete an evaluation of the CME activity. All evaluative information submitted is collected and retained, and used by Paradigm Medical Communications, LLC to continuously improve the learning experience.

Paradigm Medical Communications, LLC does not transfer, sell, or share personal information with outside parties. Paradigm Medical Communications, LLC will not otherwise disclose personal information unless required to in a legal process. Paradigm Medical Communications, LLC staff members review individual test results to the extent necessary to record and track participants’ credits.

Contact Us
If you have any questions or comments, please email us at contactus@paradigmmc.com

© 2020 Paradigm Medical Communications, LLC except where noted. Content may not be reproduced in whole or part without the express written permission of Paradigm Medical Communications, LLC.