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Reviews and Refills

Annual Reviews
Every year your child will be invited to a formal annual physiotherapy review. This review can take up to 2 hours and is an opportunity to update and discuss any changes to your child's circumstances and function. Any updates from the child's local physiotherapist and MDT are welcome.
The physiotharapy assessment may include:
Neurological examination
 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
Functional mobility, transfers and activities of daily living
• 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
After the assessment you will receive a report that will summarise the above assessments. The report will highlight the need
for any referrals/concerns and give recommendations for the future.
The annual review is an essential component of your child's ongoing ITB management.
How is the pump refilled?
The initial post-operative follow up review will occur 2-6 weeks after the pump implant in the ITB clinic. The process of
finding the ideal dose of intrathecal baclofen for the child can take several months and will involve regular reviews in
the ITB clinic.
Visits to the ITB clinic for pump refills can occur approximately every 2-6 months, depending on the baclofen dose. A strict
protocol for pump refills must be followed by the medical staff to ensure patient safety and care during ITB therapy. Clinicians
are fully trained in the procedures that are carried out. An appointment will take approximately 30 minutes and can include:
• Patient assessment/physio assessment
• Quality of life questionnaire
• Video for movement patterns, if appropriate
• General wellbeing of patient with response to the ITB therapy
• Dose adjustment as required
• Refill of pump
• Programming and confirming interval to next refill/alarm date
• Documenting patient care and prescribing information
• Educating family/patient on ITB therapy
• Scheduling next ITB therapy refill clinic date
The refill usually lasts only a few minutes and is achieved by using a syringe to inject fresh baclofen through the skin into the pump reservoir. Sometimes anaesthetic cream is used to numb the skin where the injection is made but refill procedures are generally well tolerated by patients.
What follow-up support is available?
We are always available for telephone or email advice following discharge.