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Life Care Planning for Spinal Cord Injury
Published in Roger O. Weed, Debra E. Berens, Life Care Planning and Case Management Handbook, 2018
David J. Altman, Dan M. Bagwell
Individuals with severe spasticity involving both upper and lower extremities may also benefit from the implantation of an intrathecal baclofen pump, a microprocessor controlled and programmable device that can administer miniscule quantities of medication through a catheter and into the intrathecal space, where spasticity can be greatly ameliorated with negligible systemic effects.
Management of residual physical deficits
Published in Mark J. Ashley, David A. Hovda, Traumatic Brain Injury, 2017
Velda L. Bryan, David W. Harrington, Michael G. Elliott
The problem of abnormal tone has been addressed in a variety of approaches. Most rehabilitation physicians recognize that the sedating properties of antispasticity medications can further handicap the patient. Alternatives include stretching exercises, such as proprioceptive neuromuscular facilitation,5 and local injections if just one or two limbs are involved. The patient with severe global spasticity, such as quadriplegia caused by a brain stem lesion, continues to be addressed with an intrathecal Baclofen pump. A preliminary evaluation by the physiatrist is necessary to determine if the pump will be an appropriate choice for the patient.
Patient Information – Managing Spasticity and Spasms with Exercise
Published in Valerie L. Stevenson, Louise Jarrett, Spasticity Management, 2016
Valerie L. Stevenson, Louise Jarrett
If you have an intrathecal baclofen pump, please discuss the stretches that are safe for you to do with your physiotherapist prior to commencing them. Some of the following stretches would not be advised, as they could damage the pump catheter.
Clinical assessment, management, and rehabilitation of walking impairment in MS: an expert review
Published in Expert Review of Neurotherapeutics, 2020
Bernardita Soler, Cintia Ramari, Maxime Valet, Ulrik Dalgas, Peter Feys
Gait dysfunction that is primarily a result of lower limb spasticity may be treated with medication like Baclofen, which is a derivative of γ aminobutyric acid (GABA) and it is a GABA B receptor and glycine receptor agonist that acts at spinal and supraspinal sites. The side effects of oral baclofen are dizziness, weakness, fatigue, and seizures. It is generally effective and tolerated. When spasticity is severe or the oral treatment dose is not tolerated, but control of spasticity could improve function and quality of life, intrathecal baclofen pump may be recommended. Intrathecal baclofen is administered by a programmable, subcutaneously implanted drug delivery system with a reservoir and catheter, delivering low doses of baclofen (<1% of the oral dose) [59], directly to the spinal cord. Intrathecal baclofen therapy should be considered when spasticity is inadequately managed by other treatments or side effects of such are unacceptable.
Chronic refractory constipation due to neurogenic bowel dysfunction can be successfully treated by sacral neurostimulation
Published in Acta Chirurgica Belgica, 2018
Frederiek Nuytens, Mathieu D’Hondt
In December 2014, patient was admitted to the department of gastroenterology because of chronic constipation. This constipation had begun after the cerebral hemorrhage and had worsened ever since. The implantation of the intrathecal baclofen pump had had no significant effect on patient’s complaints. Patient was unable to pass stool for up to 12 days. Defecation was painful and patient spent over more than an hour in the lavatory, only to produce a small amount of stool. There were no urinary symptoms. A review of the patient’s chronic medication did not show any medication known to cause constipation as a possible side effect. An endoscopic ultrasound showed no abnormalities. Anal manometry showed a normal sphincter tone with a resting pressure of 70 mmHg and a squeeze pressure of more than 150 mmHg. The anorectal sensory response however was clearly disturbed with a first sensation at 120 cm3. Recto-anal inhibitory reflex was present but weak. Gluteal sensation on the left-hand side was significantly less than on the right-hand side. When asked to strain, relaxation of the pelvic floor musculature was evaluated as insufficient. A therapeutic trial with neostigmine led to only a slight improvement in bowel function. Meanwhile, frequent neurological reevaluation showed no further evolution of the initial hemiparesis.