Spasticity treatment facilitates direct care delivery for adults with profound intellectual disability.
Identifieur interne : 001606 ( PubMed/Checkpoint ); précédent : 001605; suivant : 001607Spasticity treatment facilitates direct care delivery for adults with profound intellectual disability.
Auteurs : P David Charles [États-Unis] ; Chandler E. Gill ; Henry M. Taylor ; Michael S. Putman ; Caralee R. Blair ; Amanda G. Roberts ; Gregory D. Ayers ; Peter E. KonradSource :
- Movement disorders : official journal of the Movement Disorder Society [ 1531-8257 ] ; 2010.
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), Cerebral Palsy (drug therapy), Cerebral Palsy (epidemiology), Comorbidity, Epilepsy (epidemiology), Female, Hemiplegia (drug therapy), Hemiplegia (epidemiology), Humans, Injections, Intramuscular, Injections, Spinal, Intellectual Disability (epidemiology), Male, Middle Aged, Muscle Relaxants, Central (administration & dosage), Muscle Relaxants, Central (therapeutic use), Muscle Spasticity (drug therapy), Muscle Spasticity (epidemiology), Neuromuscular Agents (administration & dosage), Neuromuscular Agents (therapeutic use), Prevalence, Videotape Recording.
- 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 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.
DOI: 10.1002/mds.22995
PubMed: 20131401
Affiliations:
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Gill</name></author><author><name sortKey="Taylor, Henry M" sort="Taylor, Henry M" uniqKey="Taylor H" first="Henry M" last="Taylor">Henry M. Taylor</name></author><author><name sortKey="Putman, Michael S" sort="Putman, Michael S" uniqKey="Putman M" first="Michael S" last="Putman">Michael S. Putman</name></author><author><name sortKey="Blair, Caralee R" sort="Blair, Caralee R" uniqKey="Blair C" first="Caralee R" last="Blair">Caralee R. Blair</name></author><author><name sortKey="Roberts, Amanda G" sort="Roberts, Amanda G" uniqKey="Roberts A" first="Amanda G" last="Roberts">Amanda G. Roberts</name></author><author><name sortKey="Ayers, Gregory D" sort="Ayers, Gregory D" uniqKey="Ayers G" first="Gregory D" last="Ayers">Gregory D. Ayers</name></author><author><name sortKey="Konrad, Peter E" sort="Konrad, Peter E" uniqKey="Konrad P" first="Peter E" last="Konrad">Peter E. Konrad</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2010">2010</date><idno type="doi">10.1002/mds.22995</idno><idno type="RBID">pubmed:20131401</idno><idno type="pmid">20131401</idno><idno type="wicri:Area/PubMed/Corpus">001972</idno><idno type="wicri:Area/PubMed/Curation">001972</idno><idno type="wicri:Area/PubMed/Checkpoint">001606</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Spasticity treatment facilitates direct care delivery for adults with profound intellectual disability.</title><author><name sortKey="Charles, P David" sort="Charles, P David" uniqKey="Charles P" first="P David" last="Charles">P David Charles</name><affiliation wicri:level="1"><nlm:affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2551, USA. david.charles@vanderbilt.edu</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2551</wicri:regionArea><wicri:noRegion>Tennessee 37232-2551</wicri:noRegion></affiliation></author><author><name sortKey="Gill, Chandler E" sort="Gill, Chandler E" uniqKey="Gill C" first="Chandler E" last="Gill">Chandler E. Gill</name></author><author><name sortKey="Taylor, Henry M" sort="Taylor, Henry M" uniqKey="Taylor H" first="Henry M" last="Taylor">Henry M. Taylor</name></author><author><name sortKey="Putman, Michael S" sort="Putman, Michael S" uniqKey="Putman M" first="Michael S" last="Putman">Michael S. Putman</name></author><author><name sortKey="Blair, Caralee R" sort="Blair, Caralee R" uniqKey="Blair C" first="Caralee R" last="Blair">Caralee R. Blair</name></author><author><name sortKey="Roberts, Amanda G" sort="Roberts, Amanda G" uniqKey="Roberts A" first="Amanda G" last="Roberts">Amanda G. Roberts</name></author><author><name sortKey="Ayers, Gregory D" sort="Ayers, Gregory D" uniqKey="Ayers G" first="Gregory D" last="Ayers">Gregory D. Ayers</name></author><author><name sortKey="Konrad, Peter E" sort="Konrad, Peter E" uniqKey="Konrad P" first="Peter E" last="Konrad">Peter E. Konrad</name></author></analytic><series><title level="j">Movement disorders : official journal of the Movement Disorder Society</title><idno type="eISSN">1531-8257</idno><imprint><date when="2010" type="published">2010</date></imprint></series></biblStruct></sourceDesc></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>Cerebral Palsy (drug therapy)</term><term>Cerebral Palsy (epidemiology)</term><term>Comorbidity</term><term>Epilepsy (epidemiology)</term><term>Female</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>Male</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>Neuromuscular Agents (administration & dosage)</term><term>Neuromuscular Agents (therapeutic use)</term><term>Prevalence</term><term>Videotape Recording</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></textClass></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 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.</div></front></TEI><pubmed><MedlineCitation Owner="NLM" Status="MEDLINE"><PMID Version="1">20131401</PMID><DateCreated><Year>2010</Year><Month>03</Month><Day>23</Day></DateCreated><DateCompleted><Year>2010</Year><Month>08</Month><Day>10</Day></DateCompleted><DateRevised><Year>2013</Year><Month>11</Month><Day>21</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1531-8257</ISSN><JournalIssue CitedMedium="Internet"><Volume>25</Volume><Issue>4</Issue><PubDate><Year>2010</Year><Month>Mar</Month><Day>15</Day></PubDate></JournalIssue><Title>Movement disorders : official journal of the Movement Disorder Society</Title><ISOAbbreviation>Mov. Disord.</ISOAbbreviation></Journal><ArticleTitle>Spasticity treatment facilitates direct care delivery for adults with profound intellectual disability.</ArticleTitle><Pagination><MedlinePgn>466-73</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1002/mds.22995</ELocationID><Abstract><AbstractText>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.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Charles</LastName><ForeName>P David</ForeName><Initials>PD</Initials><AffiliationInfo><Affiliation>Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2551, USA. david.charles@vanderbilt.edu</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gill</LastName><ForeName>Chandler E</ForeName><Initials>CE</Initials></Author><Author ValidYN="Y"><LastName>Taylor</LastName><ForeName>Henry M</ForeName><Initials>HM</Initials></Author><Author ValidYN="Y"><LastName>Putman</LastName><ForeName>Michael S</ForeName><Initials>MS</Initials></Author><Author ValidYN="Y"><LastName>Blair</LastName><ForeName>Caralee R</ForeName><Initials>CR</Initials></Author><Author ValidYN="Y"><LastName>Roberts</LastName><ForeName>Amanda G</ForeName><Initials>AG</Initials></Author><Author ValidYN="Y"><LastName>Ayers</LastName><ForeName>Gregory D</ForeName><Initials>GD</Initials></Author><Author ValidYN="Y"><LastName>Konrad</LastName><ForeName>Peter E</ForeName><Initials>PE</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Mov Disord</MedlineTA><NlmUniqueID>8610688</NlmUniqueID><ISSNLinking>0885-3185</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D009125">Muscle Relaxants, Central</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D009465">Neuromuscular Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>EC 3.4.24.69</RegistryNumber><NameOfSubstance UI="D019274">Botulinum Toxins, Type A</NameOfSubstance></Chemical><Chemical><RegistryNumber>H789N3FKE8</RegistryNumber><NameOfSubstance UI="D001418">Baclofen</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName MajorTopicYN="N" UI="D000203">Activities of Daily Living</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D000328">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D000368">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D001418">Baclofen</DescriptorName><QualifierName MajorTopicYN="N" UI="Q000008">administration & dosage</QualifierName><QualifierName MajorTopicYN="Y" UI="Q000627">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D019274">Botulinum Toxins, Type A</DescriptorName><QualifierName MajorTopicYN="N" UI="Q000008">administration & dosage</QualifierName><QualifierName MajorTopicYN="Y" UI="Q000627">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D002547">Cerebral Palsy</DescriptorName><QualifierName MajorTopicYN="Y" UI="Q000188">drug therapy</QualifierName><QualifierName MajorTopicYN="Y" UI="Q000453">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D015897">Comorbidity</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D004827">Epilepsy</DescriptorName><QualifierName MajorTopicYN="N" UI="Q000453">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D005260">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D006429">Hemiplegia</DescriptorName><QualifierName MajorTopicYN="N" UI="Q000188">drug therapy</QualifierName><QualifierName MajorTopicYN="N" UI="Q000453">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D006801">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D007273">Injections, Intramuscular</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D007278">Injections, Spinal</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D008607">Intellectual Disability</DescriptorName><QualifierName MajorTopicYN="Y" UI="Q000453">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D008297">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D008875">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D009125">Muscle Relaxants, Central</DescriptorName><QualifierName MajorTopicYN="N" UI="Q000008">administration & dosage</QualifierName><QualifierName MajorTopicYN="Y" UI="Q000627">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D009128">Muscle Spasticity</DescriptorName><QualifierName MajorTopicYN="Y" UI="Q000188">drug therapy</QualifierName><QualifierName MajorTopicYN="Y" UI="Q000453">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D009465">Neuromuscular Agents</DescriptorName><QualifierName MajorTopicYN="N" UI="Q000008">administration & dosage</QualifierName><QualifierName MajorTopicYN="Y" UI="Q000627">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D015995">Prevalence</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D014743">Videotape Recording</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2010</Year><Month>2</Month><Day>5</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2010</Year><Month>2</Month><Day>5</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2010</Year><Month>8</Month><Day>11</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="doi">10.1002/mds.22995</ArticleId><ArticleId IdType="pubmed">20131401</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>États-Unis</li></country></list><tree><noCountry><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></noCountry><country name="États-Unis"><noRegion><name sortKey="Charles, P David" sort="Charles, P David" uniqKey="Charles P" first="P David" last="Charles">P David Charles</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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