Goals of ITB Therapy
Goals for managing severe spasticity are different depending on each patient’s function, comfort, and mobility.1 ITB Therapy℠ with Lioresal® Intrathecal (baclofen injection) may offer some improvements.1
Before beginning treatment for severe spasticity, a plan should be made that both establishes meaningful patient goals and includes a team for successful long-term management.1 Goals should consider the patient’s clinical presentation, time since onset of spasticity, current functional status and overall prognosis, cognitive status, and response to current or previous treatments.2 In addition, the patient’s caregiver support, access to the appropriate care team providers, and financials resources should be considered.2 Once established, goal attainment should be assessed regularly, potentially utilizing the Goal Attainment Scale.3
Keep in mind that some people with spasticity may actually use the increased muscle tone associated with the condition to help support themselves during transfers, or for sitting, standing, and walking.4 They may be doing this without even realizing it. Once treated, they may find they lose this aid in movement.1 Assessing the patient and setting goals both during a screening trial and over the long-term course of therapy can help identify and improve associated compensatory muscle weakness.4 The committed interdisciplinary management team, including the physical and occupational therapists, are important for the successful management of severe spasticity and the achievement of patient goals.5,6
The most common goals for use of ITB therapy are reduction in spasticity and spasticity-related pain, and improved function, comfort, motor control, and quality of life. However, many goals can be achieved with ITB therapy, and individual goals should be set for each patient.1
Some Goals Potentially Achieved with ITB Therapy℠ Using Lioresal® Intrathecal (baclofen injection)1
Adapted from reference 1: Saulino M, Ivanhoe CB, McGuire JR, et al. Best practices for intrathecal baclofen therapy: patient selection. Neuromodulation. 2016;19(6):607-615.
Prevention of abrupt discontinuation of intrathecal baclofen requires careful attention to programming and monitoring of the infusion system, refill scheduling and procedures, and pump alarms. Patients and caregivers should be advised of the importance of keeping scheduled refill visits and should be educated on the early symptoms of baclofen withdrawal. Special attention should be given to patients at apparent risk (eg spinal cord injuries at T-6 or above, communication difficulties, history of withdrawal symptoms from oral or intrathecal baclofen). Except in overdose related emergencies, the dose of Lioresal® Intrathecal (baclofen injection) should ordinarily be reduced slowly if the drug is discontinued for any reason.7
- Saulino M, Ivanhoe CB, McGuire JR, et al. Best practices for intrathecal baclofen therapy: patient selection. Neuromodulation. 2016;19(6):607-615.
- Elovic E, Brashear A. Chapter 9: Setting realistic and meaningful goals for treatment. In: Brashear A., Ed. Spasticity. Diagnosis and Management. 2nd ed. Demos Medical Publishing, LLC. 2016.
- Elovic E. Chapter 5: Measurement tools and treatment outcomes in patients with spasticity. In: Brashear A., Ed. Spasticity. Diagnosis and Management. 2nd ed. Demos Medical Publishing, LLC. 2016.
- Nair KP, Marsden J. The management of spasticity in adults. BMJ. 2014;349:g4737.
- Reeves S, Lambeth K. Chapter 15: The role of physical and occupational therapy in the evaluation and management of spasticity. In: Brashear A., Ed. Spasticity. Diagnosis and Management. 2nd ed. Demos Medical Publishing, LLC. 2016.
- Ridley B, Rawlins PK. Intrathecal baclofen therapy: ten steps toward best practice. J Neurosci Nurs. 2006;38(2):72-82.
- Lioresal® Intrathecal (baclofen injection) [prescribing information]. Saol Therapeutics, Roswell, Georgia; January 2019.