Children with special needs have many unique conditions.  Some special needs children require Extended and Medical Care Services due to their diagnoses:  Cerebral Palsy, Traumatic Brain Injuries, Spinal Cord injuries, etc, - each of which brings different challenges.  One of those challenges is dealing with spasticity.  Spasticity is defined as an abnormal increase in muscle tone, causing stiff tight muscles especially in the arms and legs.  Spasticity can be mild to severe and is different for everyone.  It can have a negative impact on function and comfort.  Patients with spasticity may have loss of function, pain, permanent muscle shortening or contractures.  

There are different treatments for spasticity. Depending on the severity, treatments are typically used in conjunction with other therapies.  Different treatments for spasticity range from physical and occupational therapies, braces and splints, oral medications such as baclofen, botox injections, which are injections into the actual muscles, or intrathecal baclofen therapy. Additionally, orthopedic or neurosurgical procedures may be needed to manage the spasticity or the effects of the spasticity on bones or muscles.

Intrathecal baclofen therapy requires surgery to implant a baclofen pump.  Typically the pump is placed in the abdomen of the patient.  A catheter connects to the pump and is then connected in the spinal column typically in the low to mid back region.   The pump then dispenses the medication, baclofen, at a rate prescribed by the physician.  The rate, dosage, etc can be manipulated by the physician so maximum benefits can be achieved.  The baclofen pumps do need to be refilled, based on the type of pump and the rate/dosage, refills could be weekly, monthly, or as far as six months apart.  Specialized nurses refill the baclofen pumps under the direction of the physician.   

The benefits from a baclofen pump could include relief from the pain and discomfort of spasticity, increased  range of motion, ease in stretching and providing care, improved function, and mobility and the potential to decrease the need for some orthopedic surgical procedures.

As with all treatment options, baclofen pumps need to be managed by a specialized physician.  Teaching of parents and care givers is vital to the success of treatment. Caregivers need to know the signs and symptoms of baclofen withdrawl and overdose.   Immediate physician intervention is needed if suspected withdrawl or overdose.

Again, baclofen pumps are not for everyone as everyone is unique and responds differently to spasticity.  Patients and their families must work closely with their physician to decide if the pump may be best for them.

Rebecca Weeldreyer, RN
Extended & Medical Care Manager