A Survey Summarizing Effects of the Use of

Intrathecal Baclofen on Seating and Function

Susan Johnson Taylor, OTR/L

Deborah Gaebler-Spira, MD

Sue Mukherjee, MD

It has become more common in the past few years to use the Baclofen Pump as a tool in controlling spasticity. This paper will review the decision-making processes for deciding the appropriateness of a Baclofen pump, as well as therapy for post-pump insertion. Additionally, initial results of a post pump questionnaire with clients who have received Baclofen pumps will be reviewed.

Indications for consideration for a Baclofen Pump are multi-faceted, but generally include clients who are unresponsive, or minimally responsive, to oral medication or for whom oral medication for spasticity produces undesirable side effects, such as fatigue. Some clients are on very high doses (in some cases, maximum doses) of anti-spasticity medication that is causing a high degree of side effects without a great impact on the spasticity.

Spasticity is a motor disorder characterized by velocity- dependent resistance to a passive stretch, resulting in exaggerated tendon jerks and hyperexcitability of the stretch reflex. This is caused by an imbalance between excitatory and inhibitory impulses to the alpha motor neurons. The clinical/functional consequences of spasticity can include interference with mobility and joint rangle of motion (passive and active). This leads to interference with some or all functional and activities of daily living (ADL) skills, depending on the severity of the spasticity. Because it can be difficult to “calm down” and be comfortable, particularly at night, poor sleeping habits and pain are also side effects of spasticity.

Baclofen is a gamma-butyric acid (GABA) agnonist. It is thought to act as a GABA agonist in the spinal cord by reducing positive input to the alpha motor neuron. When delivered through the implanted pump, it is delivered into the intrathecal space of the spinal cord via a catheter from the implanted pump. The goals of ITB (intrathecal Baclofen) include reduction of spasticity, reduction of pain associated with spasticity, improvement of function and facilitation of care by a caregiver.

While there are many positive effects of ITB, on of the possible side effects related to seating and some functional skills such as transferring, is hypotonia. Clinically, it was observed that some clients had developed the need for increased support from their seating system as well as a tendency toward pressure sores once the muscle bulk created by spacticity was reduced. A questionnaire was developed jointly between the RIC Physical Medicine and Rehab Dept and the RIC Seating Clinic. This questionnaire was completed with approximately 30 children and 15 adults with cerebral-based spasticity who have had ITB pump insertion for at least 3 months. They (and/or their caregiver) are being questioned as they come back into the medical clinic for pump refill.

The questionnaire includes the following areas:

¨ Age

¨ Age at implant

¨ GMFCS

¨ Dignoses, with specific questions about the presence of scoliosis, dislocated hip

¨ History of surgery prior to pump insertion

¨ Medications

¨ Current dose of Baclofen

¨ Previous seating system and problems related to skin, orthopedic, others.

¨ Changes in ADL, mobility (transfers, dressing, wheelchair mobility, etc.)

¨ Weight gain

¨ Effect on pain

¨ Hours of caregiver time required

¨ Outside participation level: education/ vocation/ home/ insitution

The desired outcome will be to gather and analyze this information and determine the types of physical/functional changes that may be expected with this diagnostic group, and how they may relate to seating and other assistive equipment changes.

Susan Johnson Taylor, OTR/L is a resource clinician at the Rehab Institute of Chicago (RIC) Seating Clinic

Dr Gaebler is a physician who specializes in pediatric PMR at the RIC.

Dr Mukherjee is a pediatric fellow in PMR at RIC

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