Faculty Collaboration Database

Spasticity treatment facilitates direct care delivery for adults with profound intellectual disability. Mov Disord 2010 Mar 15;25(4):466-73

Date

02/05/2010

Pubmed ID

20131401

DOI

10.1002/mds.22995

Scopus ID

2-s2.0-77949537815 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

Many adults with intellectual disabilities (ID) have spasticity, where increased muscle tone impairs activities of daily living (ADL) self-performance and care delivery. There are few reports of spasticity treatment for people with ID, and none of functionally meaningful outcomes. Our objective is to determine the effect of comprehensive spasticity management on ADL self-performance and care delivery. Baseline evaluation included repeated modified Ashworth and range of motion assessments, and timed and videotaped care task observations. Spasticity treatment was initiated immediately thereafter. Follow-up evaluation was conducted after spasticity management was optimized, one year after initiation. All individuals with spasticity at a single developmental center for whom treatment goals could be identified were included. Treatment was recommended by a neurologist from any accepted treatment for spasticity except oral medications, including botulinum neurotoxin A, intrathecal baclofen and orthopedic procedures. The main outcome measure is comparison of ease of videotaped care delivery, rated by direct caregivers blinded to participant treatment status. Spasticity treatment resulted in significant improvement across all outcome measures. Range of motion improved by 9 degrees (P = 0.005) and MAS by 0.4 (P = 0.022). Participants took 14% percent less time to complete tasks post-treatment (P = 0.01). Thirteen caregivers completed evaluations of 35 video pairs with an intra-class correlation of 0.9. After treatment, undergarment change (P = 0.031) and shirt change (P = 0.017) were rated easier, and all goals (P = 0.0006). Transfers trended toward improvement (P = 0.053). This study shows comprehensive spasticity management provides meaningful improvement in ADL care for patients with ID, which may improve quality of life and reduce caregiver burden.

Author List

Charles PD, Gill CE, Taylor HM, Putman MS, Blair CR, Roberts AG, Ayers GD, Konrad PE

Author

Michael Putman MD Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Activities of Daily Living
Adult
Aged
Baclofen
Botulinum Toxins, Type A
Cerebral Palsy
Comorbidity
Epilepsy
Female
Hemiplegia
Humans
Injections, Intramuscular
Injections, Spinal
Intellectual Disability
Male
Middle Aged
Muscle Relaxants, Central
Muscle Spasticity
Neuromuscular Agents
Prevalence
Videotape Recording