Spasticity treatment facilitates direct care delivery for adults with profound intellectual disability
Identifieur interne : 000287 ( Istex/Corpus ); précédent : 000286; suivant : 000288Spasticity treatment facilitates direct care delivery for adults with profound intellectual disability
Auteurs : P. David Charles ; Chandler E. Gill ; Henry M. Taylor ; Michael S. Putman ; Caralee R. Blair ; Amanda G. Roberts ; Gregory D. Ayers ; Peter E. KonradSource :
- Movement Disorders [ 0885-3185 ] ; 2010-03-15.
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- KwdEn :
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° (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
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DOI: 10.1002/mds.22995
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Roberts</name><affiliation><mods:affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="Ayers, Gregory D" sort="Ayers, Gregory D" uniqKey="Ayers G" first="Gregory D." last="Ayers">Gregory D. Ayers</name><affiliation><mods:affiliation>Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="Konrad, Peter E" sort="Konrad, Peter E" uniqKey="Konrad P" first="Peter E." last="Konrad">Peter E. 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Putman</name><affiliation><mods:affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="Blair, Caralee R" sort="Blair, Caralee R" uniqKey="Blair C" first="Caralee R." last="Blair">Caralee R. Blair</name><affiliation><mods:affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="Roberts, Amanda G" sort="Roberts, Amanda G" uniqKey="Roberts A" first="Amanda G." last="Roberts">Amanda G. Roberts</name><affiliation><mods:affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="Ayers, Gregory D" sort="Ayers, Gregory D" uniqKey="Ayers G" first="Gregory D." last="Ayers">Gregory D. Ayers</name><affiliation><mods:affiliation>Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation></author><author><name sortKey="Konrad, Peter E" sort="Konrad, Peter E" uniqKey="Konrad P" first="Peter E." last="Konrad">Peter E. Konrad</name><affiliation><mods:affiliation>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Movement Disorders</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="ISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2010-03-15">2010-03-15</date><biblScope unit="vol">25</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="466">466</biblScope><biblScope unit="page" to="473">473</biblScope></imprint><idno type="ISSN">0885-3185</idno></series><idno type="istex">35D03C312A51F78A37516F04512A9C1469BD2539</idno><idno type="DOI">10.1002/mds.22995</idno><idno type="ArticleID">MDS22995</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>activities of daily living</term><term>developmental center</term><term>direct care</term><term>intellectual disability</term><term>spasticity</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>P. David Charles MD</name><affiliations><json:string>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</json:string></affiliations></json:item><json:item><name>Chandler E. Gill BS</name><affiliations><json:string>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</json:string></affiliations></json:item><json:item><name>Henry M. Taylor MD</name><affiliations><json:string>Clover Bottom Developmental Center, Middle Tennessee Division of Mental Retardation Services, Nashville, Tennessee, USA</json:string></affiliations></json:item><json:item><name>Michael S. Putman BA</name><affiliations><json:string>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</json:string></affiliations></json:item><json:item><name>CaraLee R. Blair BA</name><affiliations><json:string>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</json:string></affiliations></json:item><json:item><name>Amanda G. Roberts BA</name><affiliations><json:string>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</json:string></affiliations></json:item><json:item><name>Gregory D. Ayers MS</name><affiliations><json:string>Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA</json:string></affiliations></json:item><json:item><name>Peter E. Konrad MD, PhD</name><affiliations><json:string>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>spasticity</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>activities of daily living</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>intellectual disability</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>direct care</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>developmental center</value></json:item></subject><language><json:string>eng</json:string></language><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° (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</abstract><qualityIndicators><score>7.804</score><pdfVersion>1.3</pdfVersion><pdfPageSize>612 x 810 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractCharCount>1900</abstractCharCount><pdfWordCount>4804</pdfWordCount><pdfCharCount>31701</pdfCharCount><pdfPageCount>8</pdfPageCount><abstractWordCount>269</abstractWordCount></qualityIndicators><title>Spasticity treatment facilitates direct care delivery for adults with profound intellectual disability</title><genre><json:string>Serial article</json:string></genre><host><volume>25</volume><pages><total>8</total><last>473</last><first>466</first></pages><issn><json:string>0885-3185</json:string></issn><issue>4</issue><subject><json:item><value>Research Article</value></json:item></subject><genre></genre><language><json:string>unknown</json:string></language><title>Movement Disorders</title><doi><json:string>10.1002/(ISSN)1531-8257</json:string></doi></host><publicationDate>2010</publicationDate><copyrightDate>2010</copyrightDate><doi><json:string>10.1002/mds.22995</json:string></doi><id>35D03C312A51F78A37516F04512A9C1469BD2539</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/35D03C312A51F78A37516F04512A9C1469BD2539/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/35D03C312A51F78A37516F04512A9C1469BD2539/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/35D03C312A51F78A37516F04512A9C1469BD2539/fulltext/tei"><teiHeader type="text"><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Spasticity treatment facilitates direct care delivery for adults with profound intellectual disability</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><availability><p>Wiley Subscription Services, Inc., A Wiley Company</p></availability><date>2010</date></publicationStmt><notesStmt><note>Medtronic, Inc.</note><note>Allergan, Inc.</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Spasticity treatment facilitates direct care delivery for adults with profound intellectual disability</title><author><persName><forename type="first">P. David</forename><surname>Charles</surname><roleName type="degree">MD</roleName></persName><note type="correspondence"><p>Correspondence: Associate Professor and Vice‐Chair of Neurology for Education and Development, Vanderbilt University Medical Center, Department of Neurology, 1161 21st Avenue South, Suite A‐1106 MCN, Nashville, TN 37232‐2551</p></note><affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation></author><author><persName><forename type="first">Chandler E.</forename><surname>Gill</surname><roleName type="degree">BS</roleName></persName><affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation></author><author><persName><forename type="first">Henry M.</forename><surname>Taylor</surname><roleName type="degree">MD</roleName></persName><affiliation>Clover Bottom Developmental Center, Middle Tennessee Division of Mental Retardation Services, Nashville, Tennessee, USA</affiliation></author><author><persName><forename type="first">Michael S.</forename><surname>Putman</surname><roleName type="degree">BA</roleName></persName><affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation></author><author><persName><forename type="first">CaraLee R.</forename><surname>Blair</surname><roleName type="degree">BA</roleName></persName><affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation></author><author><persName><forename type="first">Amanda G.</forename><surname>Roberts</surname><roleName type="degree">BA</roleName></persName><affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation></author><author><persName><forename type="first">Gregory D.</forename><surname>Ayers</surname><roleName type="degree">MS</roleName></persName><affiliation>Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation></author><author><persName><forename type="first">Peter E.</forename><surname>Konrad</surname><roleName type="degree">MD, PhD</roleName></persName><affiliation>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation></author></analytic><monogr><title level="j">Movement Disorders</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="pISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><idno type="DOI">10.1002/(ISSN)1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2010-03-15"></date><biblScope unit="vol">25</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="466">466</biblScope><biblScope unit="page" to="473">473</biblScope></imprint></monogr><idno type="istex">35D03C312A51F78A37516F04512A9C1469BD2539</idno><idno type="DOI">10.1002/mds.22995</idno><idno type="ArticleID">MDS22995</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2010</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>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</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>spasticity</term></item><item><term>activities of daily living</term></item><item><term>intellectual disability</term></item><item><term>direct care</term></item><item><term>developmental center</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>Article category</head><item><term>Research Article</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2009-05-26">Received</change><change when="2009-12-11">Registration</change><change when="2010-03-15">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/35D03C312A51F78A37516F04512A9C1469BD2539/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Wiley Subscription Services, Inc., A Wiley Company</publisherName><publisherLoc>Hoboken</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1531-8257</doi><issn type="print">0885-3185</issn><issn type="electronic">1531-8257</issn><idGroup><id type="product" value="MDS"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="MOVEMENT DISORDERS">Movement Disorders</title><title type="short">Mov. 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David</givenNames><familyName>Charles</familyName><degrees>MD</degrees></personName><contactDetails><email>david.charles@vanderbilt.edu</email></contactDetails></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Chandler E.</givenNames><familyName>Gill</familyName><degrees>BS</degrees></personName></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Henry M.</givenNames><familyName>Taylor</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Michael S.</givenNames><familyName>Putman</familyName><degrees>BA</degrees></personName></creator><creator xml:id="au5" creatorRole="author" affiliationRef="#af1"><personName><givenNames>CaraLee R.</givenNames><familyName>Blair</familyName><degrees>BA</degrees></personName></creator><creator xml:id="au6" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Amanda G.</givenNames><familyName>Roberts</familyName><degrees>BA</degrees></personName></creator><creator xml:id="au7" creatorRole="author" affiliationRef="#af3"><personName><givenNames>Gregory D.</givenNames><familyName>Ayers</familyName><degrees>MS</degrees></personName></creator><creator xml:id="au8" creatorRole="author" affiliationRef="#af4"><personName><givenNames>Peter E.</givenNames><familyName>Konrad</familyName><degrees>MD, PhD</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="US" type="organization"><unparsedAffiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="US" type="organization"><unparsedAffiliation>Clover Bottom Developmental Center, Middle Tennessee Division of Mental Retardation Services, Nashville, Tennessee, USA</unparsedAffiliation></affiliation><affiliation xml:id="af3" countryCode="US" type="organization"><unparsedAffiliation>Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA</unparsedAffiliation></affiliation><affiliation xml:id="af4" countryCode="US" type="organization"><unparsedAffiliation>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">spasticity</keyword><keyword xml:id="kwd2">activities of daily living</keyword><keyword xml:id="kwd3">intellectual disability</keyword><keyword xml:id="kwd4">direct care</keyword><keyword xml:id="kwd5">developmental center</keyword></keywordGroup><fundingInfo><fundingAgency>Medtronic, Inc.</fundingAgency></fundingInfo><fundingInfo><fundingAgency>Allergan, Inc.</fundingAgency></fundingInfo><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>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° (<i>P</i> = 0.005) and MAS by 0.4 (<i>P</i> = 0.022). Participants took 14% percent less time to complete tasks post‐treatment (<i>P</i> = 0.01). Thirteen caregivers completed evaluations of 35 video pairs with an intra‐class correlation of 0.9. After treatment, undergarment change (<i>P</i> = 0.031) and shirt change (<i>P</i> = 0.017) were rated easier, and all goals (<i>P</i> = 0.0006). Transfers trended toward improvement (<i>P</i> = 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</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn6" numbered="no"><p>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.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><!--Version 0.6 générée le 3-12-2015--><mods version="3.6"><titleInfo lang="en"><title>Spasticity treatment facilitates direct care delivery for adults with profound intellectual disability</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Spasticity Treatment for Adults with ID</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Spasticity treatment facilitates direct care delivery for adults with profound intellectual disability</title></titleInfo><name type="personal"><namePart type="given">P. David</namePart><namePart type="family">Charles</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation><description>Correspondence: Associate Professor and Vice‐Chair of Neurology for Education and Development, Vanderbilt University Medical Center, Department of Neurology, 1161 21st Avenue South, Suite A‐1106 MCN, Nashville, TN 37232‐2551</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Chandler E.</namePart><namePart type="family">Gill</namePart><namePart type="termsOfAddress">BS</namePart><affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Henry M.</namePart><namePart type="family">Taylor</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Clover Bottom Developmental Center, Middle Tennessee Division of Mental Retardation Services, Nashville, Tennessee, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Michael S.</namePart><namePart type="family">Putman</namePart><namePart type="termsOfAddress">BA</namePart><affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">CaraLee R.</namePart><namePart type="family">Blair</namePart><namePart type="termsOfAddress">BA</namePart><affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Amanda G.</namePart><namePart type="family">Roberts</namePart><namePart type="termsOfAddress">BA</namePart><affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Gregory D.</namePart><namePart type="family">Ayers</namePart><namePart type="termsOfAddress">MS</namePart><affiliation>Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Peter E.</namePart><namePart type="family">Konrad</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre authority="originalCategForm">article</genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2010-03-15</dateIssued><dateCaptured encoding="w3cdtf">2009-05-26</dateCaptured><dateValid encoding="w3cdtf">2009-12-11</dateValid><copyrightDate encoding="w3cdtf">2010</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">1</extent><extent unit="tables">3</extent><extent unit="references">35</extent><extent unit="words">5950</extent></physicalDescription><abstract lang="en">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</abstract><note type="funding">Medtronic, Inc.</note><note type="funding">Allergan, Inc.</note><subject lang="en"><genre>Keywords</genre><topic>spasticity</topic><topic>activities of daily living</topic><topic>intellectual disability</topic><topic>direct care</topic><topic>developmental center</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title></titleInfo><titleInfo type="abbreviated"><title>Mov. 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