Conflict of Interest: Vanderbilt University receives income from Allergan and Medtronic to support research efforts led by Dr.Charles including the evaluation presented in this manuscript. Dr. Charles has received income from Allergan and Medtronic for educational and consulting services. Dr. Konrad has received income from Medtronic for educational and consulting services. Ms. Gill, Dr.Taylor, Mr. Putman, Ms. Blair, Ms. Roberts, and Mr. Ayers have no conflicts to disclose.
Spasticity treatment facilitates direct care delivery for adults with profound intellectual disability
Article first published online: 3 FEB 2010
Copyright © 2010 Movement Disorder Society
Volume 25, Issue 4, pages 466–473, 15 March 2010
How to Cite
Charles, P. D., Gill, C. E., Taylor, H. M., Putman, M. S., Blair, C. R., Roberts, A. G., Ayers, G. D. and Konrad, P. E. (2010), Spasticity treatment facilitates direct care delivery for adults with profound intellectual disability. Mov. Disord., 25: 466–473. doi: 10.1002/mds.22995
- Issue published online: 16 MAR 2010
- Article first published online: 3 FEB 2010
- Manuscript Accepted: 11 DEC 2009
- Manuscript Revised: 20 SEP 2009
- Manuscript Received: 26 MAY 2009
- Medtronic, Inc.
- Allergan, Inc.
- activities of daily living;
- intellectual disability;
- direct care;
- developmental center
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° (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. © 2010 Movement Disorder Society