What is Spasticity?
Spasticity is an increase in muscle tone with uncontrolled, repeated spasms (involuntary flexing of the skeletal muscles). These spasms occur when the muscles resist being stretched. Spasms are common in children with brain or spinal cord injury.

To ease the spasms, a medicine called baclofen is given either by mouth (pral) or into the cerebral spinal fluid (intrathecal). If oral baclofen does not control the spasms, then the intrathecal baclofen may be given. To do this, a small pump is surgically placed in the child’s mid to lower abdomen. The pump will give the baclofen continuously.

Who is a Candidate for a Baclofen Pump?
Your child may benefit from a baclofen pump if he or she has:

• Severe spasms which affect the arms, legs or both
• Spasms which interfere with personal care, diapering, bathing, or sleep
• Painful spasms
• Enough body mass to support a pump (body is big enough to hold the pump) and is at least 4 years old
• A good response to a trial dose of baclofen
• Enough strength in the neck and trunk

Implanting the Pump
The infusion system consists of a pump, an intrathecal catheter and a computer. The disc-shaped pump is 3 inches wide and 1 inch thick. It uses a lithium battery which will last 3-5 years.

During surgery your child will lie on his or her side so that the back and the abdomen can be easily reached. A spinal tap (lumber puncture) is performed through a small incision in the lower back (lumbar area). A small tube (catheter) is threaded into the spinal column while the other end of the catheter is guided toward the abdomen where it is connected to the pump. The pump is programmed to give a certain amount of baclofen over 24 hours. The surgery takes 2-3 hours.

Before Surgery
To prepare for surgery, your child will receive a work-up. This includes a health history, a physical exam, and blood tests. You will talk with people from the Anesthesia Department and Admissions. You will also need to sign a consent form that states that you understand the risks and benefits of the surgery.

You child should keep taking the oral baclofen for 2-3 weeks after surgery while the pump is being programmed. Your child’s rehab doctor will discuss this with you.

After Surgery
After surgery, your child will go to the general care floor. He or she may have acetaminophen (Tylenol ®) or ibuprofen (Motrin ®) for pain. When your child is eating or drinking, the intravenous (IV) line may be removed. If your child is not having any problems, you may go home after 2-3 days. Keep the dressing clean and dry. The dressing and sutures will be removed in the neurosurgery clinic 7-10 days after surgery. The pump will be programmed and filled by the rehabilitation team every 1-3 months (more often just after the surgery). The pump has a built-in alarm for low battery and low medicine level.

In the future, your child will need antibiotics before having dental work or other invasive procedures. Your child should also wait two weeks before getting any immunizations. While the pump is in place your child should avoid:

• Extreme temperature and pressure changes
• Hot tubs
• Saunas
• Scuba diving
• Nonpressurized aircraft
• Metal detectors at airports, etc.
• MRI (magnetic resonance imaging). Check with neurosurgery or rehabilitation before receiving an MRI.

When to call
The catheter may become clogged, disconnected or infected. If this happens, your child may have:

• Redness, pain or swelling of the skin at or near the incision site
• Drainage from the incision
• Fever greater than 101.5 ° F—usually during the first six months after surgery
• Irritability or extreme sleepiness
• Nausea and vomiting
• Repeated headaches
• Little of no effect from the baclofen
  

If your child is receiving too much baclofen, he or she may be:

• Listless or extra sleepy
• Dizzy
• Lightheaded
• Breathing slowly

Whenever you have a question or a concern you should call your neurosurgeon or nurse practitioner. You can call:

The neurosurgery (Dr. Iskandar’s) office at (608) 263-9651, or Bonnie Ohm at (608) 265-2194

Copyright © 1998. University of Wisconsin Hospitals and Clinics Authority, Madison WI. All rights reserved. Written by Bonnie Ohm, RN, MS, CPNP. Reviewed by Bermans J. Iskandar, MD. Produced by the Department of Nursing. UWH #5333.