ITBIntrathecal baclofen ROM Range of motion AIM To investigate the effect of intrathecal baclofen (ITB) on function and activity in dyskinetic cerebral palsy (CP).METHOD A retrospective cohort study of records from 25 children (15 males, 10 females; mean age 10y 11mo, SD 4y 9mo). Five were classified in Gross Motor Function Classification level IV and 20 in level V. Parents were interviewed about activities in daily life, sitting, communication, pain, sleep, and gross and fine motor function. Differences before and 1 year after ITB were graded as positive, no change, or negative. Assessments of dystonia (using the Barry-Albright Dystonia Scale) and muscle tone (Ashworth Scale) were made. Joint range of motion (ROM) was measured.RESULTS Both dystonia and increased muscle tone, present in all participants before ITB, decreased after (p<0.001). Passive ROM was restricted, with no difference after. Parents reported improvements in activities in daily life (p<0.001), sitting (p<0.001), communication (p<0.001), and fine motor function (p=0.013), but no change in gross motor function. Before ITB, pain and disturbed sleep were reported. There was a reduction in pain (p=0.002) and sleep improved (p=0.004) after ITB.INTERPRETATION After ITB in individuals with dyskinetic CP, improvements were found in sitting, communication, and fine motor skills. There was a reduction in dystonia and muscle tone, and pain and sleep improved.Dyskinetic cerebral palsy (CP) is characterized by involuntary, uncontrolled, recurring, occasionally stereotyped movements. Primitive reflex patterns predominate and muscle tone varies. 1 There are two major patterns of movement disorder: dystonia and choreoathetosis. In a populationbased study of children born between 1991 and 1998 with dyskinetic CP in western Sweden, 39 out of 48 children were predominantly dystonic and there were also signs of spasticity in 33 out of 48.2 Primitive reflexes were found in 43 out of 48, with the asymmetric tonic neck reflex being the most prevalent. Most children with dyskinetic CP have a severe motor impairment, often accompanied by other problems, such as intellectual impairment and epilepsy, with increasing occurrence by severity of motor impairment.2 Communication is often hampered: most are without speech and rely on augmentative and alternative communication. However, in a recent study by Monbaliu et al., 3 almost half of the participants were able to communicate with unknown partners. Involuntary movement and primitive reflexes may disturb the use of augmentative and alternative communication, and optimal medical treatment and positioning is consequently vital to facilitate communication.Baclofen, a c-aminobutyric acid agonist, can be used orally and intrathecally to reduce dystonia and spasticity in children with CP, and has been shown to improve ease of care, reduce pain, and to be cost-effective. [4][5][6] The effect on choreoathetosis is seldom described. The continuous administration of baclofen directly into the intrathecal space requires the implant...
