The dose is titrated to provide the patient with enough spasticity to be useful in balance and positioning without being disabling. Prior to discharge, patients and their caregiver(s) are instructed on the technology, refill schedule, potential complications and adverse effects. Patient or caregiver should be supplied with oral baclofen or diazepam suppositories to manage pump dysfunction or failure.

Following implantation, aggressively attempt to increase range of motion (ROM), ambulation and gross motor skills. Night splinting and knee immobilizers can be employed to help increase ROM. Therapies can be slowly decreased to a more routine basis (ie, pre-pump implantation) after three months. Routine care is provided by the patient’s primary care physician or the referring physician.

Refills, assessments and possible dose adjustments are performed at the ITB therapy center at 4 to 12 week intervals.

Dose adjustments are based on the degree of muscle tone, severity, and frequency of spasms, presence of adverse drug effects, patient-related conditions, functional assessment and system functions. The pump should be replaced after 5 to 7 years.

Albright AL. Intrathecal baclofen in cerebral palsy movement disorders. J Child Neurol 1996;11(suppl 1):S29-S35.