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Multidimensional Assessment of Motor Function in a Child With Cerebral Palsy Following Intrathecal Administration of Baclofen

GL Almeida, PhD, PT, is Associate Professor, Instituto de Reabilitacão de Campinas, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil.
SK Campbell, PhD, PT, FAPTA, is Professor and Director of Graduate Studies, Department of Physical Therapy, College of Associated Health Professions, University of Illinois at Chicago, 1919 W Taylor St (M/C 898), Chicago, IL 60612-7251 (USA) (skc@nic.edu).
GL Girolami, PT, is Director, Pathways Center for Children, Glenview, Ill.
RD Penn, MD, is Professor, Neuroscience Institute, Neurosurgery Division, Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill.
DM Corcos, PhD, is Associate Professor, School of Kinesiology, College of Associated Health Professions, and Department of Psychology, University of Illinois at Chicago, and Department of Neurological Sciences, Rush-Presbyterian-St Luke's Medical Center.

This case report describes an 11-year-old boy with spastic diplegia whose reflex status, range of motion (ROM), strength, and motor performance were measured before and after implantation of an indwelling system for delivery of intrathecally administered baclofen. Before baclofen use, the subject experienced clonus that interfered with walking, needed assistance with transfers, and was unable to independently put on underwear and socks. Measures of spasticity, kinematics and electromyographic activity during voluntary movements, ROM, Gross Motor Function Measure (GMFM) scores, and self-reports of change were obtained at baseline, before and after bolus baclofen injection, during a double-blind placebo-controlled clinical trial of baclofen administration via an indwelling pump, and after 1 and 2 years of baclofen therapy. Spasticity, Babinski reflexes, clonus, strength, and coactivation of antagonist muscles during voluntary movement were decreased shortly after baclofen administration began. Hip and ankle ROM increased, upper-extremity movement speed increased, independence in dressing and transfers improved, and orthoses were discarded. After 1 and 2 years, GMFM scores were 7.8% and 6.4% above baseline, respectively; the subject won a fitness award. After 2 years, ROM was worse than at baseline and concerns regarding hip subluxation arose. Single-joint movement control and independence improved and spasticity decreased during baclofen administration.

Key Words: Baclofen • Cerebral palsy, drug therapy • Motor activity • Pediatrics, treatment

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