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|  Fairlawn, Area Hospitals Establish Baclofen Pump Program As a police officer and martial arts instructor, James Prouty needed a healthy body and a focused mind. He had both until a 1983 motor vehicle accident left him with a cervical myelopathy, a compression of his spinal cord that caused severe spasticity and acute, debilitating pain. Prouty's muscle spasms would come without warning, sending his arms and legs shooting straight out in an uncontrollable shaking movement. His pain, which typically snaked its way up his arms across his shoulders and into his neck and back, was far more predictable but just as persistent.
"After the surgery I was taking 17 drugs but still having problems with mobility and balance … I was on horse dosages of oral baclofen, which was affecting my mental clarity and speech," he said. Ironically, in the months ahead, baclofen would hold the key to the relief Prouty had been searching for since his injury. But first, he would have to undergo a short surgical procedure to implant a small hockey-puck-shaped device into the wall of his abdomen. The device ™ an intrathecal baclofen pump ™ delivers a liquid form of the anti-spasticity medication directly into the fluid around the spinal cord. "Baclofen works on receptors in the cord that control muscle tone and spasticity," explained Dr. Jayant Phadke, Chief of Neurology at the Worcester Medical Center and Director of Neurorehabilitation at Fairlawn Rehabilitation Hospital. "The pump delivers the medication at the highest concentration exactly where it should be --- the spinal cord." Because the baclofen does not circulate throughout the body, only small amounts are needed to relieve spasticity. This direct delivery system minimizes side effects associated with high doses of oral medications, including sedation, confusion, fatigue, constipation, and dryness of the mouth. Comprehensive Program Over the past year, Dr. Phadke and other physicians from the Worcester Medical Center, Fairlawn, and UMass Memorial have developed a comprehensive program dedicated to serving patients who could benefit from the baclofen pump. The process begins with a trial procedure in which a small dose of baclofen is injected into the spinal fluid by a lumbar puncture. "The physician and a physical therapist then observe the patient for eight hours to determine if the increased tone responds to the test dose," explained Dr. Phadke. If the patient shows improvement, a neurosurgeon then implants the device. The two-hour procedure involves an incision in the anterior abdomen for the pump; a catheter connected to the pump is then tunneled under the skin and inserted at the other end into the lumbar spine. Within 24 hours the patient is transferred to Fairlawn. There, along with monitoring fluid balance, bladder function, and the baclofen dosage, a treatment team initiates rehabilitation. "One advantage of a post-op inpatient rehabilitation stay is we can increase the pump dosage at a fairly rapid rate and then determine its functional impact. Also, many of these patients are not ambulatory when the pump goes in but become ambulatory once their spasticity is controlled. In a rehabilitation setting we can address functional mobility, ambulation, transfers, and other ways to help people become more independent," said Dr. Phadke. For James Prouty, the program has brought positive results. "His spasticity has decreased significantly," said Laura Gould, a Fairlawn physical therapist who treated Prouty before and after the implant. "His balance and ability to climb stairs have improved, and he is able to walk longer distances." Since the implant Prouty has been weaned off all other oral anti-spasticity medications and is now taking only one pain medication. "My mental clarity is much better. I no longer have that feeling of my head being sat on by an elephant," he said. Pump Refill Prouty receives regular follow-up care from a Fairlawn physiatrist who assesses the medication's effectiveness. Then, using an external programmer, the physician can adjust the baclofen dosage and refill the medication via an injection into a small port in the pump. Physicians at UMass Memorial and the Worcester Medical Center also provide this follow-up care. "After the implant I was still having problems with tone in my right leg, so the doctor increased the dosage and it helped," said Prouty, who is optimistic that continued fine-tuning will reduce some residual spasticity. Refilled every one to eight months, the pump can also be programmed to deliver varying dosages throughout the day. "Spasticity fluctuates. Some people have more at night and some during the day. The multiple dosage mechanism addresses that fluctuation," said Dr. Phadke. According to Dr. Phadke, the baclofen pump program holds great promise for improving quality of life for people with a variety of spasticity-inducing conditions. "It has proven to be successful in alleviating severe spasticity in people with Multiple Sclerosis, brain and spinal cord injury, stroke, and Cerebral Palsy," he said. "Combined with rehabilitation, it can enhance functional abilities, improve mental status, and ultimately help people to become more independent." | |||||||||
