Does Intrathecal Baclofen Therapy Lead to an Improvement in Impairments and Functional Limitations in Patients With Acquired Brain Injury (ABI)? A Retrospective Study

Abstract

Research Objectives To investigate effects of intrathecal baclofen (ITB) therapy on impairments and functional limitations in the acquired brain injury population(ABI). Design A retrospective study using chart reviews using a standardized data collection form on inpatient brain injury units to collect data on effects of ITB therapy on the ABI population with defined inclusion and exclusion criteria. A standardized data collection form was utilized along with a procedural manual for data abstraction. Setting Specialized acute and sub acute brain injury units. Participants Initially, 59 subjects were considered and a total of 15 medical records had sufficient data to analyze which met our criteria. 12 male patients (80%) and three female patients (20%). The mean age for ITB pump implantation was 35.5 years and the range was 18-67 years of age. Interventions Intrathecal Baclofen Pump Therapy with adjunctive therapies (for example skilled therapy, local Botox injections, serial casting, medication). Main Outcome Measures Modified Ashworth Scores, Passive Range of Motion, Mobility, JFK Coma Recovery Scale- Revised. Results The most significant change was noted with Modified Ashworth Scale (MAS) scores in the proximal hip muscle groups. Modified Ashworth Scale (MAS) scores with high significance (p-values ≤0.05) and large effect size (Cohen's D values >0.8) included right hip flexors, right hip extensors and R hip adductors. No statistically significant findings were found in other muscle groups, functional mobility, PROM and CRS-R (Coma Recovery Scale-Revised©) scales. Conclusions There were no significant changes noted in regards to functional status. However, data reflects improvements in spasticity of proximal hip musculature. This may result in improved positioning in bed or wheelchair as well as ease of hygiene and improved comfort. More research is recommended with a larger sample size and additional focus on pain and caregiver burden. Author(s) Disclosures All authors of this research study have no conflicts to disclose. To investigate effects of intrathecal baclofen (ITB) therapy on impairments and functional limitations in the acquired brain injury population(ABI). A retrospective study using chart reviews using a standardized data collection form on inpatient brain injury units to collect data on effects of ITB therapy on the ABI population with defined inclusion and exclusion criteria. A standardized data collection form was utilized along with a procedural manual for data abstraction. Specialized acute and sub acute brain injury units. Initially, 59 subjects were considered and a total of 15 medical records had sufficient data to analyze which met our criteria. 12 male patients (80%) and three female patients (20%). The mean age for ITB pump implantation was 35.5 years and the range was 18-67 years of age. Intrathecal Baclofen Pump Therapy with adjunctive therapies (for example skilled therapy, local Botox injections, serial casting, medication). Modified Ashworth Scores, Passive Range of Motion, Mobility, JFK Coma Recovery Scale- Revised. The most significant change was noted with Modified Ashworth Scale (MAS) scores in the proximal hip muscle groups. Modified Ashworth Scale (MAS) scores with high significance (p-values ≤0.05) and large effect size (Cohen's D values >0.8) included right hip flexors, right hip extensors and R hip adductors. No statistically significant findings were found in other muscle groups, functional mobility, PROM and CRS-R (Coma Recovery Scale-Revised©) scales. There were no significant changes noted in regards to functional status. However, data reflects improvements in spasticity of proximal hip musculature. This may result in improved positioning in bed or wheelchair as well as ease of hygiene and improved comfort. More research is recommended with a larger sample size and additional focus on pain and caregiver burden.