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Oral motor, communication, and nutritional status of children during intrathecal baclofen therapy: a descriptive
Kristie F Bjornson1, John F McLaughlin, John D Loeser
1Children's Hospital and Regional Medical Center, Neurodevelopmental Clinic, Spasticity Management Clinic, Seattle, WA, USA. kristie.bjornson@seattlechildrens.org
Insights
Intrathecal baclofen (ITB) therapy in children with cerebral spasticity showed improvements in speech, communication, and saliva control. However, feeding and nutritional status changes were less pronounced, with some children experiencing altered bowel movements.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Neuroscience
Background:
- Spasticity in children, often of cerebral origin, significantly impacts motor function and daily activities.
- Intrathecal baclofen (ITB) therapy is a treatment option for severe spasticity, but its effects on non-motor functions require detailed investigation.
- Understanding the comprehensive impact of ITB is crucial for optimizing patient care and management strategies.
Purpose of the Study:
- To evaluate the oral motor, communication, and nutritional status in pediatric patients undergoing ITB therapy for cerebral spasticity.
- To identify potential benefits and drawbacks of ITB therapy beyond spasticity reduction.
- To inform the development of management guidelines for ITB therapy in children.
Main Methods:
- An observational, cross-sectional pilot study was conducted at a tertiary-care children's hospital.
- Thirty children with cerebral spasticity receiving ITB therapy participated.
- Data were collected via a structured interview focusing on communication, speech, feeding, nutrition, oral motor function, and gastrointestinal function, with severity assessed using the Gross Motor Function Classification System (GMFCS).
Main Results:
- Improvements were observed in speech (10 children), use of assistive communication technology (6 children), self-feeding (9 children), cup drinking (12 children), and indicating thirst (9 children).
- Saliva control improved in 10 children, while 8 experienced worsening.
- Gastrointestinal function, specifically stool frequency, worsened in 14 children, with 8 of these in GMFCS level V.
Conclusions:
- ITB therapy demonstrated positive effects on certain aspects of speech, communication, and saliva control in children with cerebral spasticity.
- Changes in feeding and nutritional status were less consistent, and gastrointestinal issues like stool frequency require attention.
- The findings support the development of prospective management guidelines correlating ITB-induced spasticity changes with objective oral motor, communication, and nutritional outcomes.
Objective:
To describe the oral motor, communication, and nutritional status of children receiving intrathecal baclofen (ITB) therapy for spasticity of cerebral origin.
Design:
Observational cross-sectional design.
Setting:
Tertiary-care regional children's hospital.
Participants:
Thirty children with spasticity of cerebral origin receiving ITB therapy.
Interventions:
Not applicable.
Main Outcome Measures:
One interviewer administered a structured in-person interview tool designed for this pilot study, data from which were collapsed into 4 change categories: communication and speech, feeding and nutrition, oral motor function, and gastrointestinal function. Functional severity was ranked with the Gross Motor Function Classification System (GMFCS).
Results:
Speech: 10 improved (5 in GMFCS level V) and 2 worsened. Use of assistive technology to communicate: 6 improved (5 in GMFCS level V). Appetite: 10 improved (6 in GMFCS level V) and 4 worsened. Self-feeding: 9 improved (2 in GMFCS level III, 4 in level IV, 3 in level V) and 2 worsened. Saliva control: 10 improved (1 in GMFCS level III, 1 in level IV, 8 in level V) and 8 worsened. Cup drinking: 12 improved (5 in GMFCS level V) and 2 worsened. Indicates thirst: 9 improved (4 in GMFCS level IV, 5 in level V) and none worsened. Stool frequency: 8 improved (8 in GMFCS level V) and 14 worsened.
Conclusions:
Some aspects of speech, communication, and saliva control seemed to have improved, with bowel movement frequency decreased in some children receiving ITB. Fewer changes in feeding and nutritional status were reported. On the basis of this pilot study, prospective management guidelines are proposed that relate objective outcome measures of oral motor function, communication, and nutrition to changes in spasticity with ITB.
