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Intrathecal baclofen therapy for spastic hypertonia in chronic traumatic brain injury
Gerard E Francisco1, Juan M Latorre, Cindy B Ivanhoe
1Physical Medicine and Rehabilitation Alliance, Baylor College of Medicine and University of Texas Health Sciences Center, Houston, USA. gerard.e.francisco@uth.tmc.edu
Objective:
To describe the outcome of intrathecal baclofen (ITB) therapy in treating spastic hypertonia and its sequelae in individuals with chronic (>14 years) traumatic brain injuries (TBI).
Design:
Case series.
Setting:
Free-standing rehabilitation hospital.
Participants:
Three adult males who received a TBI 14, 17.1, and 19.9 years prior to receiving ITB pump.
Outcome Measures:
Modified Ashworth Scale (MAS); Functional Independence Measure (FIM)-mobility scores; and informal functional evaluation.
Intervention:
ITB therapy.
Results:
MAS scores of the five most hypertonic muscles in the affected lower limbs improved following of ITB therapy. FIM-mobility scores did not change from baseline, but certain functional domains improved, such as gait, transfers, and sitting; decreased assistance for activities of daily living (ADL) and nursing care; decreased painful spasms; and increased community mobility and participation in recreational activities.
Conclusion:
ITB therapy is still beneficial even >14 years after TBI onset. In spite of the absence of improvement in FIM scores, functional enhancements in areas not measured by traditional scales can still be achieved. This suggests that in this patient population consideration for ITB therapy should not be based solely on conventional assessment scales.
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