Palanichamy R1
1Swansea University, United Kingdom, College of Human and Health Science, Swansea, United Kingdom
Background: Spasticity and associated problems can go unrecognized and untreated amongst people with cerebral palsy and intellectual disabilities. Researches have shown that in spite of higher healthcare needs than the general population people with intellectual disabilities has poorer health outcomes and are prone to risk of developing comorbidities. Although people with cerebral palsy are living longer the quality of life remains the same.
Purpose: The main purpose for this narrative review is to analyse and describe the best available evidence for spasticity intervention in Cerebral Palsy for people with Intellectual Disabilities and provide the clinicians an overview of how the evidence could be used to inform decision-making, compare and choose the appropriate intervention in this population. This would be comprehensive resource for physiotherapy practitioners for evidence implementation of these interventions. This review also assisted in identifying the gaps in evidence and to discover new research areas.
Methods: A critical review of research literature published in English language from 1994 to 2014 was conducted. The Studies were critically appraised and comparatively analysed in cerebral palsy population. In this narrative review AACPDM (American Academy of Cerebral Palsy and Developmental Medicine) methodology was followed to present the evidence in an organised fashion. The reviewer has analysed the collected data and synthesized all the information based on the outcome measures in the studies using a hierarchy of research design rigour
Results: There are extensive researches highlighting the needs for people with intellectual disabilities however there are barriers while applying in clinical practice as the quality of evidences for spasticity interventions are low and the complications are high. The findings offer deeper insight into the spasticity and its associated problems and the role of multidisciplinary team members while planning the treatment goals. Further research work is indicated in this population to develop SMART goals for the spasticity intervention to improve the quality of life.
Conclusion(s): Several conclusions can be drawn from this narrative review.
1. Spasticity in People with Intellectual disabilities are under-recognised and undertreated, particularly amongst those with severe and profound intellectual disabilities.
2. The use of BTX-A injections and ITB has shown positive outcome even in participants who had a very long-standing spasticity and are wheelchair dependent. These positive outcomes demonstrated improvement in care delivery and facilitated activities of daily living with a goal focused interventions.
Implications: Although muscle tone has been a focus of physical therapy interventions in the past, current rehabilitation practice favours medical or surgical interventions such as use of intrathecal baclofen, use of botulinum toxin A or selective posterior rhizotomy for the management of spasticity along with physiotherapy.
The musculoskeletal problems of spasticity that people with ID experience may not be communicated so awareness of the condition and its available interventions should be raised among the health professionals, staff and the care givers.
The quality of life (QOL) of a person with spasticity in cerebral palsy improves due to the reduction in pain and prevention of secondary complications. This is cost effective as the time spent providing care to patients could potentially be decreased.
Keywords: Spasticity, physiotherapy
Funding acknowledgements: The review was partly funded by the reviewer and the directorate of learning disability in ABMU Health board (NHS Wales)UK.
Purpose: The main purpose for this narrative review is to analyse and describe the best available evidence for spasticity intervention in Cerebral Palsy for people with Intellectual Disabilities and provide the clinicians an overview of how the evidence could be used to inform decision-making, compare and choose the appropriate intervention in this population. This would be comprehensive resource for physiotherapy practitioners for evidence implementation of these interventions. This review also assisted in identifying the gaps in evidence and to discover new research areas.
Methods: A critical review of research literature published in English language from 1994 to 2014 was conducted. The Studies were critically appraised and comparatively analysed in cerebral palsy population. In this narrative review AACPDM (American Academy of Cerebral Palsy and Developmental Medicine) methodology was followed to present the evidence in an organised fashion. The reviewer has analysed the collected data and synthesized all the information based on the outcome measures in the studies using a hierarchy of research design rigour
Results: There are extensive researches highlighting the needs for people with intellectual disabilities however there are barriers while applying in clinical practice as the quality of evidences for spasticity interventions are low and the complications are high. The findings offer deeper insight into the spasticity and its associated problems and the role of multidisciplinary team members while planning the treatment goals. Further research work is indicated in this population to develop SMART goals for the spasticity intervention to improve the quality of life.
Conclusion(s): Several conclusions can be drawn from this narrative review.
1. Spasticity in People with Intellectual disabilities are under-recognised and undertreated, particularly amongst those with severe and profound intellectual disabilities.
2. The use of BTX-A injections and ITB has shown positive outcome even in participants who had a very long-standing spasticity and are wheelchair dependent. These positive outcomes demonstrated improvement in care delivery and facilitated activities of daily living with a goal focused interventions.
Implications: Although muscle tone has been a focus of physical therapy interventions in the past, current rehabilitation practice favours medical or surgical interventions such as use of intrathecal baclofen, use of botulinum toxin A or selective posterior rhizotomy for the management of spasticity along with physiotherapy.
The musculoskeletal problems of spasticity that people with ID experience may not be communicated so awareness of the condition and its available interventions should be raised among the health professionals, staff and the care givers.
The quality of life (QOL) of a person with spasticity in cerebral palsy improves due to the reduction in pain and prevention of secondary complications. This is cost effective as the time spent providing care to patients could potentially be decreased.
Keywords: Spasticity, physiotherapy
Funding acknowledgements: The review was partly funded by the reviewer and the directorate of learning disability in ABMU Health board (NHS Wales)UK.
Topic: Disability & rehabilitation
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: Narrative review
All authors, affiliations and abstracts have been published as submitted.
