Effect of Intrathecal Baclofen Bolus Injection on Lower Extremity Joint Range of Motion During Gait in Patients With Acquired Brain Injury
published online 16 November 2009.
Abstract
Horn TS, Yablon SA, Chow JW, Lee JE, Stokic DS. Effect of intrathecal baclofen bolus injection on lower extremity joint range of motion during gait in patients with acquired brain injury.
Objectives
To evaluate lower extremity joint range of motion (ROM) during gait before and after intrathecal baclofen (ITB) bolus administration, and to explore the relation between changes in ROM and concurrent changes in gait speed and muscle hypertonia.
Design
Case series.
Setting
Tertiary care rehabilitation center.
Participants
Adults (N=28) with muscle hypertonia due to stroke, trauma, or anoxia.
Interventions
50-μg ITB bolus injection via lumbar puncture (75 and 100μg in 2 cases).
Main Outcome Measures
Ashworth score, self-selected gait speed, and sagittal plane ROMs in hip, knee, and ankle joints before and 2, 4, and 6 hours after ITB bolus.
Results
A significant decrease in the mean Ashworth score on the more involved side (2.0 to 1.3) and an increase in gait speed (41 to 47cm/s) were noted at different intervals after ITB bolus injection. Ankle ROM significantly increased on the more involved (13° to 15°, P<.01) and less involved (22° to 24°, P<.05) sides. ROM significantly improved, significantly worsened, or showed no significant change in 42%, 34%, and 24% of individual joints, respectively. The peak change in ROM did not coincide with the peak decrease in Ashworth score. Peak changes in ROM and speed coincided more often (P<.001) in participants who increased gait speed after ITB bolus compared with those who decreased speed. The absolute change in ROM after ITB bolus injection correlated better with the concurrent changes in speed (r=.41, P<.001) than with the baseline speed (r=.18, P<.05).
Conclusions
ITB bolus injection produces variable changes in joint ROM during gait, with significant improvements in the ankles only. Timing and magnitude of peak changes in ROM are associated with concurrent changes in speed but not muscle hypertonia.
Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS
Correspondence to Dobrivoje S. Stokic, MD, DSc, Methodist Rehabilitation Center, 1350 E Woodrow Wilson Dr, Jackson, MS 39216
Supported in part by the National Institute on Disability and Rehabilitation Research (grant nos. H133A020514 and H133A980035), the U.S. Department of Education, Medtronic, Inc, research grants, and the Wilson Research Foundation, Jackson, MS.
A commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit on the author or one or more of the authors. Yablon is a consultant for Medtronic Inc, which manufactures intrathecal baclofen pumps.
ABSTRACT