Objective： To evaluate the effects of botulinum toxin type A (BTX-A) injection combined with serial plaster casting on fine motor function and upper limb spasticity in children with spastic cerebral palsy (CP).

Methods： A total of 119 children with CP were stratified according to clinical subtype and Manual Ability Classification System (MACS) level, and then randomly divided into an experimental group (n=61) and a control group (n=58) using a random number table. The control group received a single BTX-A injection combined with conventional upper limb rehabilitation training and guidance. The experimental group received additional serial plaster casting. Therapeutic effects were assessed using the Fine Motor Function Measure (FMFM) and the Modified Tardieu Scale (MTS), which assessed spasticity using parameter X, before BTX-A injection, at 1 month, and at 3 months after injection.

Results： At 1 month after treatment, FMFM scores and MTS parameter X scores significantly improved in both groups (P < 0.05), with the experimental group showing superior outcomes compared to the control group (P < 0.05). At 3 months, all scores in the experimental group remained improved despite a slight decrease, while in the control group, all indicators except for elbow extension showed no statistically significant difference compared to those at 1 month post-treatment.

Conclusion： BTX-A combined with conventional upper limb rehabilitation training can significantly improve upper limb muscle spasticity and large-joint motor function in children with CP. The addition of serial plaster casting helps to further enhance hand function and prolong the therapeutic effect.