Care provider assessment of intrathecal baclofen in children

Abstract

Intrathecal baclofen is used increasingly to manage severe spasticity in children. Before implanting the baclofen pump, care providers typically ask how it will benefit their child. The purpose of this study was to describe the perceptions of care providers about intrathecal baclofen for management of spasticity in 80 individuals (52 males, 28 females). The individuals were younger than 22 years at the time of implantation (mean age 11 years, SD 5 years; range 3 to 21 years). Participants had been implanted with the pump for a minimum of one year at the time of evaluation. The most common diagnoses were quadriplegic and diplegic cerebral palsy and traumatic brain injury. Most participants were at level IV and V on the Gross Motor Function Classification System. After pump implantation most participants had tone reduction on the Ashworth scale of 1 to 1.9 in the lower extremities and 0 to 0.9 in the upper extremities. Lower extremity range of motion was maintained in 43 of 51 individuals (84%) and lost in 8 participants (16%). Complications requiring surgery occurred in 63 of a larger group of 152 patients (incidence per patient-year of follow-up was 0.19). Thirty-one of the 80 children had orthopedic procedures after pump placement. Only one of these was unexpected and none had rapid progression of scoliosis. Most treatment goals were achieved. Goals most commonly chosen (decreased pain, prevention of worsening of deformity, and improved ease of care) were improved in 91%, 91%, and 88% of participants respectively. Ninety-five per cent of care providers agreed that they would have this procedure performed again (81% strongly agreed, 14% slightly agreed). All care providers reported improvement in scores on the Caregiver Questionnaire. This information has been helpful to families considering intrathecal baclofen therapy.

Moderate-to-Severe Traumatic Brain Injury in Children: Complications and Rehabilitation Strategies

“…If focal treatment is ineffective and more general relief is indicated, insertion of a baclofen pump may be instituted for continuous intrathecal medication infusion. However, the inserted pump may interfere with the ability to ambulate and has inherent risks associated with placement (Gooch, Oberg, Grams, Ward, & Walker, 2004). Surgical interventions such as selective rhizotomy, tenotomy, or myotomy are reserved for failure of pharmacologic and physiotherapy management to achieve patient goals.…”

The management of scoliosis in children with cerebral palsy: a review

“…The use of ITB pumps, which deliver a continuous infusion, offers improvement in spasticity, ease of care and reduction in pain (29). There is conflicting evidence as to whether ITB pumps can cause progression of a scoliosis.…”

Orthopedic surgery in children with intrathecal baclofen pumps

“…Intrathecal baclofen (ITB) has been used to effectively decrease spasticity in children. Many studies have documented a significant reduction in spasticity in children who receive this treatment [1][2][3][4][5][6][7][8].…”

“…The conclusion was that ITB infusion for treatment of spasticity reduced the need for subsequent orthopedic surgery. Gooch et al reported that 31 of 80 children (39%) had orthopedic surgery during a mean follow-up time of 23 months following baclofen pump implantation [7]. Review of pre-implantation range of motion measurements indicated that orthopedic surgery would be expected in all of the patients except one.…”