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Spasticity in adults living in a developmental center
Alyssa A Pfister1, Amanda G Roberts, Henry M Taylor
1Division of Movement Disorders, Dept. of Neurology, Vanderbilt University Medical Center, 2100 Pierce Avenue, Nashville, TN 37212-3375, USA.
Objectives:
To ascertain the prevalence of spasticity among adults living in a developmental center and to document the development of spasticity treatment plans for this population.
Design:
Descriptions of the clinical features of medical disorders and a prevalence survey.
Setting:
Residential developmental center.
Participants:
One hundred three adults.
Interventions:
Not applicable.
Main Outcome Measures:
Characteristics described included the prevalence of spasticity in this population, the specific spasticity diagnosis, functional goals for spasticity treatment identified by the participants' multidisciplinary teams, and the specific treatment indicated by the neurologist.
Results:
Of the 103 people diagnosed by the neurologist, 24 had diplegic spasticity, 4 had hemiplegic spasticity, 44 had quadriplegic spasticity, and 31 had no spasticity. Functional goals identified by multidisciplinary teams were undergarment change (46.3% of the persons for whom goals were identified), splinting hands (11%), dressing (57.4%), hygiene (20.4%), wheelchair positioning (25.9%), ambulation improvement (14.8%), and transfers (9.3%). After physical and occupational therapy, the first invasive treatments indicated for people with spasticity included botulinum toxin injections (60%), intrathecal baclofen (26.4%), orthopedic surgery (5.6%), and medication (1.4%). No treatment was recommended for 25% of the spasticity patients.
Conclusions:
The prevalence of spasticity was 35% in this developmental center population of 205 individuals. A multidisciplinary team approach to the evaluation of adults with spasticity who live in a developmental center makes it possible to identify functional goals that are amenable to spasticity treatment and minimizes treatment that does not target specific functional goals.