From the Guidelines
Deterioration in motor function in adults with cerebral palsy (CP) can occur due to several etiologies, and management should begin with a comprehensive evaluation to identify the specific cause, as treatment depends on the underlying etiology, as noted in a recent study 1. The most common causes of deterioration in motor function in adults with CP include premature aging of the musculoskeletal system, increased spasticity, development of secondary conditions like arthritis or degenerative joint disease, pain syndromes, and overuse injuries.
- Neurological factors may include progression of the original brain injury, development of new neurological conditions, or cervical myelopathy from spinal stenosis.
- Metabolic causes such as weight gain, deconditioning, and fatigue can also contribute to functional decline. Interventions may include physical therapy to maintain strength and range of motion, medication adjustments for spasticity (such as baclofen 10-25mg three times daily, botulinum toxin injections, or intrathecal baclofen therapy), pain management, assistive device updates, and addressing any orthopedic issues that may have developed, as supported by studies 1. Early intervention is crucial as adults with CP often experience functional decline at younger ages than the general population, and regular monitoring by a multidisciplinary team familiar with adult CP is recommended to detect and address changes before significant functional loss occurs, as highlighted in recent research 1. Key considerations in managing deterioration in motor function in adults with CP include:
- Comprehensive evaluation to identify the underlying cause of deterioration
- Individualized treatment plans based on the specific etiology and needs of the patient
- Regular monitoring and adjustments to treatment as needed to prevent further decline and optimize quality of life.
From the Research
Deterioration in Motor Function in Adulthood
- Cerebral palsy is a group of permanent disorders of movement and/or posture and motor function, which can lead to muscle spasticity and impact an individual's functionality and quality of life 2.
- Spasticity is a common disability in children with cerebral palsy, and its treatment is multidisciplinary, including pharmacological and physical interventions 3.
- In adulthood, patients with a history of cerebral palsy may experience deterioration in motor function due to various factors, including spasticity, which can be managed with treatments such as intrathecal baclofen infusion and botulinum toxin combined treatment 2.
Etiologies and Treatment Options
- The etiologies of cerebral palsy are multiple and result in brain injury that affects movement, posture, and balance 4.
- Treatment options for spasticity in cerebral palsy include oral medications, intrathecal baclofen, and chemodenervation agents such as botulinum toxins, phenol, and alcohol 3, 5.
- Botulinum toxin A is an effective anti-spasticity treatment in children with cerebral palsy, but more data is needed on its safety and long-term effects 3.
- Intrathecal baclofen infusion and botulinum toxin combined treatment have been shown to be effective and safe in managing spasticity, pain, quality of life, and self-care in cerebral palsy patients 2.
Management of Spasticity
- Spasticity can be managed with a combination of pharmacological and non-pharmacological interventions, including physical therapy, occupational therapy, and orthopedic surgery 5, 4.
- The goal of treatment is to reduce spasticity and improve motor function, while also considering the potential impact on posture and ability to ambulate 5.
- Botulinum neurotoxins (BoNTs) have been shown to be effective in treating spasticity in adults and children with cerebral palsy, with a good safety profile 6.