OBJECTIVE: To describe the oral motor, communication, and nutritional status of children receiving intrathecal baclofen (ITB) therapy for spasticity of cerebral origin. DESIGN: Observational cross-sectional design. SETTING: Tertiary-care regional children's hospital. PARTICIPANTS: Thirty children with spasticity of cerebral origin receiving ITB therapy. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: One interviewer administered a structured in-person interview tool designed for this pilot study, data from which were collapsed into 4 change categories: communication and speech, feeding and nutrition, oral motor function, and gastrointestinal function. Functional severity was ranked with the Gross Motor Function Classification System (GMFCS). RESULTS: Speech: 10 improved (5 in GMFCS level V) and 2 worsened. Use of assistive technology to communicate: 6 improved (5 in GMFCS level V). Appetite: 10 improved (6 in GMFCS level V) and 4 worsened. Self-feeding: 9 improved (2 in GMFCS level III, 4 in level IV, 3 in level V) and 2 worsened. Saliva control: 10 improved (1 in GMFCS level III, 1 in level IV, 8 in level V) and 8 worsened. Cup drinking: 12 improved (5 in GMFCS level V) and 2 worsened. Indicates thirst: 9 improved (4 in GMFCS level IV, 5 in level V) and none worsened. Stool frequency: 8 improved (8 in GMFCS level V) and 14 worsened. CONCLUSIONS: Some aspects of speech, communication, and saliva control seemed to have improved, with bowel movement frequency decreased in some children receiving ITB. Fewer changes in feeding and nutritional status were reported. On the basis of this pilot study, prospective management guidelines are proposed that relate objective outcome measures of oral motor function, communication, and nutrition to changes in spasticity with ITB.
OBJECTIVE: To describe the oral motor, communication, and nutritional status of children receiving intrathecal baclofen (ITB) therapy for spasticity of cerebral origin. DESIGN: Observational cross-sectional design. SETTING: Tertiary-care regional children's hospital. PARTICIPANTS: Thirty children with spasticity of cerebral origin receiving ITB therapy. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: One interviewer administered a structured in-person interview tool designed for this pilot study, data from which were collapsed into 4 change categories: communication and speech, feeding and nutrition, oral motor function, and gastrointestinal function. Functional severity was ranked with the Gross Motor Function Classification System (GMFCS). RESULTS: Speech: 10 improved (5 in GMFCS level V) and 2 worsened. Use of assistive technology to communicate: 6 improved (5 in GMFCS level V). Appetite: 10 improved (6 in GMFCS level V) and 4 worsened. Self-feeding: 9 improved (2 in GMFCS level III, 4 in level IV, 3 in level V) and 2 worsened. Saliva control: 10 improved (1 in GMFCS level III, 1 in level IV, 8 in level V) and 8 worsened. Cup drinking: 12 improved (5 in GMFCS level V) and 2 worsened. Indicates thirst: 9 improved (4 in GMFCS level IV, 5 in level V) and none worsened. Stool frequency: 8 improved (8 in GMFCS level V) and 14 worsened. CONCLUSIONS: Some aspects of speech, communication, and saliva control seemed to have improved, with bowel movement frequency decreased in some children receiving ITB. Fewer changes in feeding and nutritional status were reported. On the basis of this pilot study, prospective management guidelines are proposed that relate objective outcome measures of oral motor function, communication, and nutrition to changes in spasticity with ITB.