Disclosures: Jeremy Roberts, MD: No financial relationships or conflicts of interest

Case Diagnosis: Pain and Spasticity in Adults with Cerebral Palsy returning to the pediatric physiatrist decades later.

Case Description: Nine patients aged 28-59 with spastic and/or dystonic cerebral palsy (one hemiplegic, two quadriplegic, six diplegic) presented to pediatric physiatry after many years without physiatric care. There were 2, 2, 1, & 4 patients of GMFCS 1, 2, 3, & 4, respectively. Chief complaints included pain in seven patients, tone and gait management in three, and hygiene related concerns in one. Four had prior surgeries for tone management including dorsal rhizotomy, heel cord lengthening, and hip osteotomies. Baclofen was the most common medication used for hypertonia and pain. Most patients had proximal hypertonia only and four had hypertonia in all lower extremity muscle groups. All 9 patients received Onabotulinumtoxin A (400U being the most common dose) injection. Pain was relieved along with improved hygiene care and gait. Relief and symptom improvement lasted approximately 5-6 months before subsequent injections were required. Two patients were referred for ITB placement and one for total hip arthroplasty.

Setting: Tertiary Care HospitalAssessment/

Results: Many patients initiated care or returned to Pediatric Physiatry for assistance with pain and improved walking or ADLs. After botulinum toxin injections, their conditions improved overall.

Discussion: Transition of care is challenging for patients with cerebral palsy, and they are at risk for receiving insufficient care in adulthood. Following up even after many years was beneficial, and our patients’ principal problems, (pain, decreased mobility, hygiene, and limited ADLs) were appropriately managed. Improved transition of care may have saved them years of functional loss and pain.

Conclusion: Worsening of spasticity and dystonia was the main reason for increased pain in this group. Additionally, hypertonia associated with limited range of motion affected their mobility, hygiene care, and ADLs significantly. They unanimously demonstrated improvement after botulinum toxin injection.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/coming-back-to-physiatry-after-decades-a-case-series/