Description
The intrathecal baclofen (ITB) pump is a very useful tool for managing advanced spasticity in adults and children, but it can bring a wide range of difficulties and complications. This session is case-based. Faculty will present real-world patient scenarios, and the audience will work through each one to build confidence in troubleshooting this vulnerable patient population. Each case covers one or more of the following:
1. Why an on-call protocol matters in cases of withdrawal, from the emergency department to the neuro ICU.
2. Diagnostic tests that show whether the baclofen pump and catheter are working properly.
3. Treatment of acute baclofen withdrawal.
4. When to consult the implanting surgeon if the pump malfunctions.
5. Differential diagnosis when the pump loses efficacy.
The cases will also highlight how to build and coordinate a care team across settings to support these patients.
There is no one-size-fits-all approach to baclofen pump management, and physicians practice in many different settings. Working through the cases together and discussing how each might be handled in different settings, will help train the next generation of physiatrists to treat this undertreated population with spasticity more confidently.
Learning Objectives
By the end of this session, participants will be able to:
- Learning Objective 1: Apply a step-by-step approach to managing a baclofen pump that may be malfunctioning, including understanding PM&R’s role in recognizing and treating acute withdrawal, using case examples from the ED through the neuro ICU.
- Learning Objective 2: Choose the right diagnostic tests to troubleshoot a pump or catheter that may be malfunctioning, and decide when to escalate to the implanting surgeon, using case-based scenarios.
- Learning Objective 3: Describe the key members and roles of a multidisciplinary team for managing patients with baclofen pumps, including on-call coverage, emergency and ICU staff, and implanting surgeons, using case examples
Principle Faculty
Zachary Bohart, MD, FAAPMR
Kimberly Heckert, MD, FAAPMR
Michael Saulino, MD, PhD., FAAPMR
AAPM&R Medical Education Committee
Rachel Brakke Holman, MD - Nothing to Disclose
Sarah M. Eickmeyer, MD - Nothing to Disclose
Chelsea D. Frost, MD, MS - Nothing to Disclose
David J. Haustein, MBA,MD,MBA: PM Consulting, Ownership or Partnership; Expert Medical Consulting, Ownership or Partnership; Greene County Medical Society Executive Council, Non-remunerative Positions of Influence; Missouri State Medical Foundation Board, Non-remunerative Positions of Influence; Vice President of the Missouri State Medical Society, Non-remunerative Positions of Influence
Sarah K. Hwang, MD - Nothing to Disclose
Ravi E. Kasi, MD - Nothing to Disclose
Caroline Pupke, DO - Nothing to Disclose
Monica E. Rho, MD - Nothing to Disclose
McCasey R. Smith, MD - Nothing to Disclose
Jennifer A. Soo Hoo, MD - Nothing to Disclose
Brionn K. Tonkin, MD - Nothing to Disclose
Stephanie Tow, MD: US Paralympics Swimming Team Head Physician, Other - Please specify; United States Olympic & Paralympic Committee, Honorarium
Justin L. Weppner, DO - Nothing to Disclose
Alexandra G. Wolfe, DO - Nothing to Disclose
FDA Disclosures
Any faculty member for this activity who intends to discuss or demonstrate any pharmaceutical or medical device for which FDA clearance has not been approved, will verbally disclose the FDA’s classification at the beginning of their presentation or demonstration.