Spasticity interventions in cerebral palsy for people with and without intellectual disabilities - a comparative analysis

Purpose

The main purpose for this narrative literature 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.

Spasticity in People with Intellectual disabilities are under-recognised
and undertreated, particularly amongst those with severe and profound intellectual disabilities.

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.

Approach

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.

Outcomes

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.

Several conclusions can be drawn from this narrative literature 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 Intellectual Disability 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.

Fund acknowledgements

This narrative literature review is carried out as a part of MSc study (Chronic condition management) with Swansea university and it is partly funded by the reviewer and by the Learning Disability directorate in Swansea Bay University Health board (NHS in Wales).

Additional notes

This work was presented at Physiotherapy UK 2019 and at 11th May World Congress WCPT 2019, Geneva, Switzerland - Shortlisted and scheduled for an interactive session with a poster