1 / 14

Intrathecal Baclofen: Increasing Patient Functionality

Intrathecal Baclofen: Increasing Patient Functionality. Mary Elizabeth S. Nelson DNP, ANP-BC Nurse Practitioner, Milwaukee, WI. A thorough evaluation is the key. Core evaluation should be a combination of subjective & objective spasticity assessments, strength and comorbid issues

fruma
Download Presentation

Intrathecal Baclofen: Increasing Patient Functionality

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Intrathecal Baclofen: Increasing Patient Functionality Mary Elizabeth S. Nelson DNP, ANP-BC Nurse Practitioner, Milwaukee, WI.

  2. A thorough evaluation is the key • Core evaluation should be a combination of subjective & objective spasticity assessments, strength and comorbid issues • Optional tools include Ashworth score, Tardieu scale, Spasm frequency scale, COPM, etc. • Formal PT and OT evaluations helpful • Mandatory piece is goal setting to determine spasticity impact on QOL and function

  3. Focus on Goals • Goal is NOT the elimination of spasticity • Goal IS functional spasticity control • Goal of surgery is to place device and heal from surgery • Setting realistic expectations is key to patient satisfaction

  4. Goals through the process • Surgery: Place device and heal from surgery • Post op: Wean oral antispasmodics while titrating dose • Maintenance: Titrate dose to BALANCE positive and negative symptoms • Optimize outcomes; consider function, position, ROM, hygiene, etc.

  5. Dosing decisions • Standard to start at 2x trial dose unless trial dose caused loss of function due to weakness or dose lasted longer than 6-8 hours. • Adjust dose approximately 10-20% in clinic. Our max increase is 30%. • Some populations require miniscule changes (MS) and those that trial dose lasted greater than 6-8 hours • Should be able to duplicate trial response

  6. Environmental considerations • Dosing may be different inpatient vs. outpatient • Inpatient: Controlled environment, may adjust as often as every 24 hours • Outpatient: Rely on patients assessment, may adjust weekly • Ranges: Spinal: 10 – 30%. Cerebral 5 – 15% Pediatric 5 – 15% • After 60 days label states Spinal 10 – 40% and Cerebral 5 – 20%

  7. Flex dosing considerations • Most frequently add bolus dose when patients can identify a time of day that they suffer from increased spasticity • Conversely will decrease dose during hours patient identifies as being too weak • “One change at a time” is a good rule to follow • Will consider Flex around 200 mcg/day if patients tone not adequately controlled

  8. Additional considerations • Idea of a bolus is to provide a “boost” of drug. Run it as quickly as possible • Advisable to start bolus dose no more than 20-30% of daily dose • If patient tolerated a 50 mcg trial dose can generally tolerate 50 mcg bolus • Best to provide too small a dose than too large and work dose up over time

  9. Identification of problems • Implant occurred after positive response to trial dose, should be able to reproduce • Systematic work-up is best practice to identify system problems • When developing an algorithm consider plain films, side port access, dose ranges, dye studies, fluro/CT/Nuclear med access

  10. Remember noxious stimuli • Pain • Infection • Constipation • Immobility • Incisions • Quick titration of oral antispasmodic agents • UTI • Pressure sores • Addition of SSRI, stimulants, diet medications and Betaseron • Anxiety

  11. Don’t limit your treatment • Wean oral medications and optimize pump • If focal areas of spastic tone limit patient include botulinum toxin injections in treatment • MUST stretch and exercise a muscle that’s been loosened • PT, OT, ST, RT, Aquatic therapy, Hippo therapy • Braces, Splints, Dynamic stretch • Orthopedic surgery once spasticity treated • Treatment of noxious stimuli and underlying diseases

  12. Additional thoughts • When patients are anesthetized spasticity is eliminated but contracture remains • If tone altered to quickly can not adjust into movement or strengthen underlying muscles quickly enough • Combination treatments may have synergistic effect • Different dosing patterns result in different responses, try delivering dose differently

  13. Take away • Goal is to improve patients Quality of Life • Functional spasticity control! • Wean oral antispasmodics to reduce side effects • Treat noxious stimuli and concurrent issues • Stretch muscles and joints • Optimize dosing to offer the greatest benefit

  14. Q&A time…… • Questions? • Thank you! • Mary Elizabeth S. Nelson, DNP

More Related