The contribution of tone to resting energy expenditure in children
with moderate to severe cerebral palsy: Evaluation utilizing intrathecal
baclofen injection
Affiliations: Stanford University School of Medicine, VA Palo Alto
Health Care System, Palo Alto, CA, USA | Department of Pediatrics, University of Utah, Salt
Lake City, UT, USA | Department of Physical Medicine and Rehabilitation,
University of Utah Medical Center, Salt Lake City, UT, USA
Note: [] Corresponding author: Lisa Samson-Fang, Department of
Pediatrics, University of Utah School of Medicine, 50 North Medical Drive, Salt
Lake City, UT 84132, USA. Tel.: +1 801 585 1017; Fax: +1 801 581 3899; E-mail:
Lisa.Samson-Fang@HSC.Utah.EDU
Abstract: The extent to which high muscle tone contributes to the caloric
needs of children with cerebral palsy (CP) is debated. Understanding its
contribution is important in predicting calorie needs in this population which
frequently experiences under nutrition. Intrathecal baclofen is an innovative
therapy now used for treatment of excessive tone. We prospectively studied the
changes in resting energy expenditure (REE) observed in 12 children with CP
undergoing intrathecal baclofen injection. REE was measured in the fasting
state before intrathecal injection of 50 micrograms of baclofen. Patients
remained fasting and REE measures were repeated four hours later. Tone changes
were assessed using the Modified Ashworth Scale at the same time points. One
child was excluded from study because he became increasingly agitated over the
observation period and one child demonstrated no tone reduction after the
baclofen injection. In the remaining 10 patients, the average REE prior to
injection was 101 ± 17% of predicted and decreased to
84 ± 24% of predicted after injection (p<0.004). This study
suggests that tone contributes substantially to the caloric needs of children
with CP and must be carefully considered when providing nutritional
recommendations.
