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Assessment and Pre-Op



What happens in the initial assessment?

The child will have an outpatient appointment to be assessed by a Neurologist and a Specialist Physiotherapist in the Complex Movement Disorder Clinic. Current treatments will be reviewed, and potential treatment options discussed as appropriate. This may include a discussion regarding implantation of an intrathecal baclofen (ITB) pump. We will require your child to undress to an appropriate level to carry out a complete assessment. Please bring appropriate clothing - shorts and a vest top is recommended. Please bring any walking aids or orthotics which your child normally uses.

What will a physiotherapy assessment include?
Neurological examination:
• Reflexes
• Nature of tone, i.e. spasticity/rigidity/dystonia/dyskinesia.
• Formal spasticity assessment using the Modified Ashworth Score (MAS)
• Spasticity  triggers and variability, e.g. pain/emotion/startle response to sudden noise or movement
Musculoskeletal screen: • Muscle power as appropriate • Muscle selectivity • Range of movement assessment • X-rays if appropriate
Functional mobility, transfers and activities of daily living: • Some of this information may be gathered through a Quality of Life questionnaire. • Motor function assessment, as appropriate • Gait pattern, as appropriate • Upper limb function
Observations regarding: • Patterns of posture and movement. This is sometimes best captured using a video camera (relevant consent is always sought prior to any filming) • Posture/positioning issues • Moving and handling difficulties • Pain behaviour • Upper limb function
What happens at the pre-operative clinic appointment?
During this clinic appointment the procedure will be described in detail to the family including the risks and possible adverse 
effects. Potential disadvantages to ITB therapy will also be discussed.
Realistic objectives of ITB therapy will be discussed and agreed collaboratively with the parents, including the importance of 
regular attendance in ITB clinics for refill and follows up. If ITB is not deemed to be the best treatment option, patients will 
be discharged from the ITB service back to their referrer with a report to detail the assessment findings.