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Care provider assessment of intrathecal baclofen in children
Judith L Gooch1, Wende A Oberg, Barbara Grams
1Primary Children's Medical Center, University of Utah Health Sciences Center, 100 North Medical Drive, Salt Lake City, Utah 84113, USA. pcjgooch@IHC.com
Insights
Intrathecal baclofen pumps significantly reduced spasticity and improved care goals for children with severe conditions. Most caregivers would repeat the procedure, reporting overall positive outcomes and improved quality of life.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Rehabilitation Medicine
Background:
- Intrathecal baclofen (ITB) therapy is increasingly utilized for managing severe spasticity in pediatric populations.
- Caregiver perspectives are crucial in evaluating the benefits of ITB therapy before pump implantation.
- Spasticity in children often results from conditions like cerebral palsy and traumatic brain injury.
Purpose of the Study:
- To describe care provider perceptions of intrathecal baclofen therapy for managing spasticity in pediatric patients.
- To evaluate the effectiveness of ITB therapy in achieving treatment goals and improving functional outcomes.
- To assess caregiver satisfaction and willingness to undergo the procedure again.
Main Methods:
- A study involving 80 pediatric patients (under 22 years) with spasticity, implanted with baclofen pumps for at least one year.
- Data collected on patient diagnoses, Gross Motor Function Classification System levels, and Ashworth scale for tone reduction.
- Assessment of range of motion, complications, orthopedic procedures, achievement of treatment goals, and caregiver questionnaire scores.
Main Results:
- Significant tone reduction observed in lower (1-1.9) and upper (0-0.9) extremities post-ITB implantation.
- Treatment goals such as decreased pain (91%), preventing deformity (91%), and improving ease of care (88%) were largely achieved.
- 95% of caregivers would opt for the procedure again, with all reporting improvements on the Caregiver Questionnaire.
Conclusions:
- Intrathecal baclofen therapy is effective in managing severe spasticity in children, leading to significant functional improvements.
- The therapy successfully addresses key caregiver-identified goals, enhancing the quality of life for both patients and families.
- High caregiver satisfaction underscores the value and positive impact of ITB therapy in pediatric neurorehabilitation.
Abstract:
Intrathecal baclofen is used increasingly to manage severe spasticity in children. Before implanting the baclofen pump, care providers typically ask how it will benefit their child. The purpose of this study was to describe the perceptions of care providers about intrathecal baclofen for management of spasticity in 80 individuals (52 males, 28 females). The individuals were younger than 22 years at the time of implantation (mean age 11 years, SD 5 years; range 3 to 21 years). Participants had been implanted with the pump for a minimum of one year at the time of evaluation. The most common diagnoses were quadriplegic and diplegic cerebral palsy and traumatic brain injury. Most participants were at level IV and V on the Gross Motor Function Classification System. After pump implantation most participants had tone reduction on the Ashworth scale of 1 to 1.9 in the lower extremities and 0 to 0.9 in the upper extremities. Lower extremity range of motion was maintained in 43 of 51 individuals (84%) and lost in 8 participants (16%). Complications requiring surgery occurred in 63 of a larger group of 152 patients (incidence per patient-year of follow-up was 0.19). Thirty-one of the 80 children had orthopedic procedures after pump placement. Only one of these was unexpected and none had rapid progression of scoliosis. Most treatment goals were achieved. Goals most commonly chosen (decreased pain, prevention of worsening of deformity, and improved ease of care) were improved in 91%, 91%, and 88% of participants respectively. Ninety-five per cent of care providers agreed that they would have this procedure performed again (81% strongly agreed, 14% slightly agreed). All care providers reported improvement in scores on the Caregiver Questionnaire. This information has been helpful to families considering intrathecal baclofen therapy.
