Spasticity treatment facilitates direct care delivery for adults with profound intellectual disability
Identifieur interne : 001A00 ( Main/Exploration ); précédent : 001999; suivant : 001A01Spasticity treatment facilitates direct care delivery for adults with profound intellectual disability
Auteurs : P. David Charles [États-Unis] ; Chandler E. Gill [États-Unis] ; Henry M. Taylor [États-Unis] ; Michael S. Putman [États-Unis] ; Caralee R. Blair [États-Unis] ; Amanda G. Roberts [États-Unis] ; Gregory D. Ayers [États-Unis] ; Peter E. Konrad [États-Unis]Source :
- Movement Disorders [ 0885-3185 ] ; 2010-03-15.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
- Activities of Daily Living, Adult, Aged, Baclofen (administration & dosage), Baclofen (therapeutic use), Botulinum Toxins, Type A (administration & dosage), Botulinum Toxins, Type A (therapeutic use), Care, Cerebral Palsy (drug therapy), Cerebral Palsy (epidemiology), Comorbidity, Daily living, Epilepsy (epidemiology), Female, Handicap, Hemiplegia (drug therapy), Hemiplegia (epidemiology), Humans, Injections, Intramuscular, Injections, Spinal, Intellectual Disability (epidemiology), Intellectual deficiency, Male, Mental retardation, Middle Aged, Muscle Relaxants, Central (administration & dosage), Muscle Relaxants, Central (therapeutic use), Muscle Spasticity (drug therapy), Muscle Spasticity (epidemiology), Nervous system diseases, Neuromuscular Agents (administration & dosage), Neuromuscular Agents (therapeutic use), Prevalence, Spasticity, Treatment, Videotape Recording, activities of daily living, developmental center, direct care, intellectual disability, spasticity.
- MESH :
- chemical , administration & dosage : Baclofen, Botulinum Toxins, Type A, Muscle Relaxants, Central, Neuromuscular Agents.
- chemical , therapeutic use : Baclofen, Botulinum Toxins, Type A, Muscle Relaxants, Central, Neuromuscular Agents.
- drug therapy : Cerebral Palsy, Hemiplegia, Muscle Spasticity.
- epidemiology : Cerebral Palsy, Epilepsy, Hemiplegia, Intellectual Disability, Muscle Spasticity.
- Activities of Daily Living, Adult, Aged, Comorbidity, Female, Humans, Injections, Intramuscular, Injections, Spinal, Male, Middle Aged, Prevalence, Videotape Recording.
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
Url:
DOI: 10.1002/mds.22995
Affiliations:
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Ayers</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee</wicri:regionArea><placeName><region type="state">Tennessee</region></placeName></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 wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee</wicri:regionArea><placeName><region type="state">Tennessee</region></placeName></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>Adult</term><term>Aged</term><term>Baclofen (administration & dosage)</term><term>Baclofen (therapeutic use)</term><term>Botulinum Toxins, Type A (administration & dosage)</term><term>Botulinum Toxins, Type A (therapeutic use)</term><term>Care</term><term>Cerebral Palsy (drug therapy)</term><term>Cerebral Palsy (epidemiology)</term><term>Comorbidity</term><term>Daily living</term><term>Epilepsy (epidemiology)</term><term>Female</term><term>Handicap</term><term>Hemiplegia (drug therapy)</term><term>Hemiplegia (epidemiology)</term><term>Humans</term><term>Injections, Intramuscular</term><term>Injections, Spinal</term><term>Intellectual Disability (epidemiology)</term><term>Intellectual deficiency</term><term>Male</term><term>Mental retardation</term><term>Middle Aged</term><term>Muscle Relaxants, Central (administration & dosage)</term><term>Muscle Relaxants, Central (therapeutic use)</term><term>Muscle Spasticity (drug therapy)</term><term>Muscle Spasticity (epidemiology)</term><term>Nervous system diseases</term><term>Neuromuscular Agents (administration & dosage)</term><term>Neuromuscular Agents (therapeutic use)</term><term>Prevalence</term><term>Spasticity</term><term>Treatment</term><term>Videotape Recording</term><term>activities of daily living</term><term>developmental center</term><term>direct care</term><term>intellectual disability</term><term>spasticity</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Baclofen</term><term>Botulinum Toxins, Type A</term><term>Muscle Relaxants, Central</term><term>Neuromuscular Agents</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Baclofen</term><term>Botulinum Toxins, Type A</term><term>Muscle Relaxants, Central</term><term>Neuromuscular Agents</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Cerebral Palsy</term><term>Hemiplegia</term><term>Muscle Spasticity</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Cerebral Palsy</term><term>Epilepsy</term><term>Hemiplegia</term><term>Intellectual Disability</term><term>Muscle Spasticity</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Activities of Daily Living</term><term>Adult</term><term>Aged</term><term>Comorbidity</term><term>Female</term><term>Humans</term><term>Injections, Intramuscular</term><term>Injections, Spinal</term><term>Male</term><term>Middle Aged</term><term>Prevalence</term><term>Videotape Recording</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Arriération mentale</term><term>Déficience intellectuelle</term><term>Handicap</term><term>Hypertonie spastique</term><term>Pathologie du système nerveux</term><term>Soin</term><term>Traitement</term><term>Vie quotidienne</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><affiliations><list><country><li>États-Unis</li></country><region><li>Tennessee</li></region></list><tree><country name="États-Unis"><region name="Tennessee"><name sortKey="Charles, P David" sort="Charles, P David" uniqKey="Charles P" first="P. David" last="Charles">P. David Charles</name></region><name sortKey="Ayers, Gregory D" sort="Ayers, Gregory D" uniqKey="Ayers G" first="Gregory D." last="Ayers">Gregory D. Ayers</name><name sortKey="Blair, Caralee R" sort="Blair, Caralee R" uniqKey="Blair C" first="Caralee R." last="Blair">Caralee R. Blair</name><name sortKey="Gill, Chandler E" sort="Gill, Chandler E" uniqKey="Gill C" first="Chandler E." last="Gill">Chandler E. Gill</name><name sortKey="Konrad, Peter E" sort="Konrad, Peter E" uniqKey="Konrad P" first="Peter E." last="Konrad">Peter E. Konrad</name><name sortKey="Putman, Michael S" sort="Putman, Michael S" uniqKey="Putman M" first="Michael S." last="Putman">Michael S. Putman</name><name sortKey="Roberts, Amanda G" sort="Roberts, Amanda G" uniqKey="Roberts A" first="Amanda G." last="Roberts">Amanda G. Roberts</name><name sortKey="Taylor, Henry M" sort="Taylor, Henry M" uniqKey="Taylor H" first="Henry M." last="Taylor">Henry M. Taylor</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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