Children with a form of cerebral palsy (CP) may have difficulty moving their bodies the way they want to due to problems with the way their nerves “talk” to their muscles.

Spasticity and increased muscle tone are common side effects of CP and are characterized by a stiffening of the muscles especially, if the child is trying to do something quick, like walking or reaching out to get a toy. 

Some of these children may take an oral medication called baclofen, to help relax their muscles with good results. Other children may need something more than the oral medication. For these children, baclofen can be administered directly to the spinal cord.

A baclofen pump is a device that is implanted under the skin that delivers this medicine directly to the spinal cord to relax stiff muscles. At Duke University Hospital, the neurosurgeons have perfected a technique known as the baclofen pump trial. 

It is sometimes difficult to determine just how the muscles will react to certain amounts of this medicine. This trial allows for the assessment of specific doses of the medicine to try to determine the correct dosage, and also, if this child is a good candidate for a baclofen pump. 

A child being considered for a baclofen pump will first undergo a baclofen pump trial.  It begins with a small surgery to insert a small tube very close to the child’s spinal cord. The neurosurgeon then visits the child in their hospital room on three consecutive days.

On each day, the child is visited first by a physical therapist to expertly assess the child’s baseline muscle tone and spasticity. The neurosurgeon then administers a predetermined amount of the medicine through the tube. The physical therapist will reassess the child after the medicine has had a chance to take effect and report back to the neurosurgeon.

The team, along with the parents, makes decisions about the effectiveness of the dose and determines the dosage for the next day. The third day is used to more specifically fine-tune the dose and to ultimately determine if the child is a good candidate for a more permanent baclofen pump.

Physical Therapy Treatment

In-hospital physical therapy treatments include:

• Range of motion (ROM) assessment
• Muscle tone assessment
• Spasticity assessment
• Gait and physical functioning assessment
• Discussion with team on patient’s candidacy for the baclofen pump