Spasticity Management Program
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Severe spasticity is a common symptom in patients with neurological disorders and
represents a major clinical challenge to health care professionals.
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The disabling effects of spasticity can interfere with the activities of daily living and lead to a myriad of complications, including pain, impaired mobility, sleep disruption, depression,
progressive scoliosis, and contractures. Real-world cases of spasticity are often more complex than classical textbook descriptions, making appropriate diagnosis and treatment planning challenging and frustrating for both patients and clinicians.
The Alta Bates Summit Spasticity Management Program meets the challenges of providing up-to-date, multidisciplinary and comprehensive care for these patients.
A Multidisciplinary Team Approach
The Alta Bates Summit Spasticity Management Program is a truly multidisciplinary team. It features the combined expertise and experience of multiple specialists:
Rehabilitation Nurse Practitioner Barbara Ridley, RN, FNP coordinates the team. Ms. Ridley has gained national recognition for her expertise in this field, serving as faculty in national training programs on the management of intrathecal baclofen. Ms. Ridley coordinates the spasticity management program.
Alta Bates Summit physiatrists Hussam El Gohary, MD; Herb Goodman, MD; and Dougal MacKinnon, MD lead the rehabilitation team that includes physical therapists, occupational therapists, speech pathologists and neuropsychologists.
Neurologist Joanna Cooper, MD of East Bay Region Associates in Neurology who
administers Botulinum toxin in selected patients and performs the test dose of intrathecal baclofen, in addition to providing input on medical management
Lawrence Dickinson, MD of Pacific Brain and Spine, who does the implantation of intrathecal devices.
Eric Gaensler, MD from Neuroradiology who assists in trouble-shooting diagnostics
as needed.
Comprehensive Patient Care
The Spasticity Management Program offers a full range of individualized treatment options and takes advantage of the full continuum of care, including:
• The Acute Inpatient Rehabilitation Unit’s comprehensive rehabilitation program
• Extensive inpatient services for spasticity patients needing acute
medical care
• Comprehensive outpatient rehabilitation services
Following an initial patient assessment, the spasticity management team develops a treatment plan according to individual patient needs. The Rehabilitation Nurse Practitioner coordinates each patient’s treatment plan and follow-up care, and confers regularly with other members of the spasticity management team and family members to review and modify the treatment plan according to patient progress and needs.
Treatment Options
Mild cases of spasticity often respond well to conservative treatment approaches that may include one or more of the following:
• Well-established, FDA approved antispastic oral medications such as baclofen, dantrolene, tizanidine, or gabapentin, as well as non FDA-approved medications
• Physical medicine modalities such as stretching, positioning, cryotherapy, splinting or inhibitory casting
• Reduction of factors such as poor positioning, pressure from devices or recurrent infections that may increase spasticity.
For patients with more severe cases of spasticity, Alta Bates Summit offers several additional treatment options, including:
• Botulinum toxin injections or motor nerve point blocks
• Intrathecal Baclofen (ITB) Therapy (also called the Baclofen Pump)
approved by the FDA for treating spasticity of both spinal cord and
cerebral origin.
Established in 1996, the Alta Bates Summit ITB Program has become one of the largest in the state and is a recognized Center of Excellence for this therapy.
A Special Note about ITB Therapy
ITB Therapy works by injecting Baclofen via a catheter directly into the cerebrospinal fluid surrounding the spinal cord. The catheter connects to an infusion pump implanted under the skin of the abdomen.
Because the delivery of drug is direct to the site of action, patients achieve relaxation with very small doses – as little as 1/100th of the typical oral dose. This increases effectiveness and helps reduce undesirable side effects such as drowsiness and weakness, common with oral antispastic medications.
Before they receive an infusion system, patients receive a test dose of baclofen through lumbar puncture performed by Dr. Cooper. If the test dose is found to be effective, plans are made for implantation of a permanent infusion system.
Following surgical implantation by Dr. Dickinson, patients have a brief stay at the Alta Bates Summit Inpatient Rehabilitation unit where rehabilitation specialists work to improve the patient’s functional status and begin the process of optimizing the dosage of infused baclofen. On-going follow-up and refills of the pump’s medication reservoir are performed in the Outpatient Rehabilitation Clinic.
Contact Us
For more information about the program, please contact Barbara Ridley, RN, FNP, Spasticity Program Coordinator at (510) 204-5259.
References
Albright AL, Gilmartin R, Swift D et al (2003). Long-term intrathecal Baclofen for
severe spasticity of cerebral origin. Journal of Neurosurg: 98: 291-295.
Francisco GE (2001). Intrathecal Baclofen Therapy for stroke-related spasticity.
Topics Stroke Rehabil: 8(1): 36-46.
Ridley, B & Rawlins, K (2006). Intrathecal Baclofen Therapy: Ten Steps Towards Best Practice. Journal of Neuroscience Nursing, 38: 72-82.
Sampson FC, Hayward A, Evans G et al (2002). Functional benefits and cost/benefit
analysis of continuous intrathecal Baclofen infusion for the management of severe spasticity. Journal of Neurosurg: 96(6): 1052-1057.
Stempien L, Tsai T. (2000). Intrathecal Baclofen pump use for spasticity: A clinical survey. Am Journ Phys Med Rehabil: 79(6): 536-541.
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