MULTIDIMENSIONAL ASSESSMENT OF MOTOR FUNCTION IN A CHILD WITH CEREBRAL-PALSY FOLLOWING INTRATHECAL ADMINISTRATION OF BACLOFEN

This case report describes an Ii-year-old boy with spastic diplegia wh ose reflex status, range of motion (ROM), strength, and motor performa nce were measured before and after implantation of an indwelling syste m for delivery of intrathecally administered baclofen. Before baclofen use, the subject experienced clonus that interfered with walking, nee ded assistance with transfers, and was unable to independently put on underwear and socks. Measures of spasticity, kinematics and electromyo graphic activity during voluntary movements, ROM, Gross Motor Function Measure (GMFM) scores, and self-reports of change were obtained at ba seline, before and after bolus baclofen injection, during a double-bli nd placebo-controlled clinical trial of baclofen administration via an indwelling pump, and after 1 and 2 years of baclofen therapy. Spastic ity, Babinski reflexes, clonus, strength, and coactivation of antagoni st muscles during voluntary movement were decreased shortly after bacl ofen administration began. Hip and ankle ROM increased, upper-extremit y movement speed increased, independence in dressing and transfers imp roved, and orthoses were discarded. After I and 2 years, GMFM scores w ere 7.8% and 6.4% above baseline, respectively; the subject won a fitn ess award. After 2 years, ROM was worse than at baseline and concerns regarding hip subluxation arose. Single-joint movement control and ind ependence improved and spasticity decreased during baclofen administra tion.