Spasticity treatment facilitates direct care delivery for adults with profound intellectual disability.
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.
Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2551, USA. david.charles@vanderbilt.edu
P David
PD
Charles
Chandler E
CE
Gill
Henry M
HM
Taylor
Michael S
MS
Putman
Caralee R
CR
Blair
Amanda G
AG
Roberts
Gregory D
GD
Ayers
Peter E
PE
Konrad
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001418:Baclofen / Q000008:administration & dosage / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000453:epidemiology*; D015897:Comorbidity; D004827:Epilepsy / Q000453:epidemiology; D005260:Female; D006429:Hemiplegia / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007273:Injections, Intramuscular; D007278:Injections, Spinal; D008607:Intellectual Disability / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000627:therapeutic use*; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000453:epidemiology*; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015995:Prevalence; D014743:Videotape Recording
D009125:Muscle Relaxants, Central; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; D001418:Baclofen