Yale Family Papers The Yale Family Papers contain papers of Linus Yale, Sr. Tower Laboratories sells high-dose vitamin C, lysine and proline drink mixes for coronary heart disease as recommended by Nobel Prize-winning scientist Linus Pauling. RPT LINUS Literasi Tahun 2 RPT LINUS Literasi Tahun 1 Saya bukan cikgu LINUS. Bahan LINUS 2.0 Wednesday, 31 July 2013. Perlulah mempunyai kreativiti dalam menghasilkan kualiti yang terbaik.Disini saya kumpulkan 25 contoh terbaik bagi rujukan designer atau sesiapa saja yang. A conspiracy to defame John A. Andrew : being a review of the proceedings of Joel Parker, Linus Child and Leverett Saltonstall at the People's Convention, so called. Pamphlet Program Linus SekolahIntrathecal Baclofen Therapy for Spasticity Intrathecal Baclofen Therapy for Spasticity. What is intrathecal baclofen therapy, and how does it fit into the spectrum of spasticity management options for individuals with spinal cord injury? In this SCI Forum, Rina Reyes, MD, Medical Director, UW Medicine SCI Rehabilitation Program and Assistant Professor, UW Department of Rehabilitation Medicine, provided in- depth information about when to consider an implanted, programmable baclofen pump for spasticity management; the process of being evaluated for this treatment; the potential advantages, limitations, and drawbacks to the pump; and requirements to maintain a baclofen pump. In addition, a panel of individuals (two with spinal cord injury and one with MS) who have implanted baclofen pumps discussed their reasons for choosing the device and what the experience has been like for them. Read the report or watch the video on this page. Presentation time: 8. Pamphlet Program Linus NumerasiAfter watching, please complete our two- minute survey. Intrathecal Baclofen Therapy for Spasticity. By Rina Reyes, Medical Director, UW Medicine SCI Rehabilitation and UWMC Rehabilitation Intrathecal Baclofen Program Table of Contents. What is the intrathecal baclofen pump? The intrathecal baclofen pump is a surgically implanted system used to control spasticity by infusing baclofen directly into the spinal canal and around the spinal cord. The contractions can cause involuntary jerking and difficulty relaxing, coordinating or controlling movement. Spasticity is often triggered by ordinary activities such as stretching, changing positions, or even just a touch. The symptoms and severity of spasticity vary widely from person to person, even with the same type or level of injury. Spasticity can have beneficial or negative effects on function; sometimes the effects are a mixture of both. Benefits include increased or preserved muscle tone, improved circulation, and even enabling you to stand, transfer or empty your bladder. On the other hand, spasms can be painful or so strong that they interfere with transfers, seating, sleeping, or performing daily activities. In deciding whether or how to treat your spasticity, ask yourself: Is it causing me more problems than benefits? Will reducing my spasticity lead to an improvement in my ability to do things? Generally it is a good idea to treat spasticity if it is causing these problems: Significantly interfering with voluntary movement. Difficulty maintaining range of motion or position. Affecting safety. Contributing to pain or skin breakdown. Making personal care difficult for you or your caregiver. Spasticity occurs in up to 7. SCI, and 4. 9% or more require treatment of some kind. Positioning, splints (orthotics) or braces, taping. Physical and occupational therapy. Electrical or vibratory stimulation to the opposing muscle to attempt to relax the spastic muscle. Heat or ice. Massage. Serial or inhibitory casting – a process of repeatedly and progressively casting a limb closer to the desired position in order to “reset” muscle stretch reflexes and lengthen muscles/tendons. Aquatic therapy. The advantage to these non- pharmacologic measures is that they have minimal side effects and can be used in addition to medications. These work well in reducing spasticity for some people, but not for others. For some, these measures are not sufficient to control the muscle tightness or spasms to the extent they desire. Pharmacologic methods (medications)Focal (localized) treatments. Sometimesnerve blocks or injections of anesthetics, alcohol or phenol, or neurotoxins such as botulinum toxin (Botox, Myobloc, Dysport) are used if spasticity that requires treatment is limited to one or a small area of the body. Oral medications. People with SCI usually have more extensive spasticity, however, so oral medications are often needed. Examples of these medications include baclofen, tizanidine, clonidine, benzodiazepines such as diazepam or clonazipam, gabapentin and dantrolene. Although these oral medications are very effective in treating spasticity, they have several disadvantages: Since the medications affect the whole body you may get unwanted side effects such as sedation (sleepiness) and fatigue. You may need several doses daily. Concentration in your system varies according to how recently you took your last dose, and this may cause peaks and valleys in spasticity control. You may need periodic blood monitoring for some of these drugs that can have potential side effects on liver function or blood counts. Some can interact with other medications. What method should you try? Considerations: What are your goals for treatment of your spasticity? What is the distribution of spasticity in your body? How reversible do you want the treatment strategy to be? What are the potential side effects? What other health conditions do you have that could be affected by your treatment choice? This system delivers baclofen directly to where it is needed—into the intrathecal space inside the spinal canal that contains the fluid that bathes the spinal cord. Limits or eliminates the common undesirable side effects associated with taking oral medications for spasticity. It can deliver a precise and consistent drug dose throughout the day, so you avoid the peaks and valleys of taking oral medication. Dosing is very flexible and can be programmed any way you need it, from the same dose administered on an hourly basis 2. Components. Pump — a metal canister containing the battery, the programmable component that stores information, and the drug reservoir. The pump is surgically implanted under skin in the lower abdomen on either the right or the left side. Catheter — connected to the pump, it runs under the skin and enters the spinal canal in the low back. The tip of the catheter is placed into the intrathecal space and advanced higher to a predetermined location, depending on how much spasticity you have in your arms, your trunk, and your legs. Programmer — an external handheld system used by your provider to read the pump information and reprogram pump using radiotelemetry. How does it work? Medication is instilled into the reservoir inside the pump. Inert gas inside the pump creates pressure on the expandable reservoir, pushing medication into the internal tubing. Battery- powered microprocessor controls the flow rate by operating the rotor, which drives the medication through the tubing into the catheter. Medication flows slowly through the catheter into the spinal fluid.? Refills. You must visit your physician or pump manager regularly to have the pump refilled with baclofen before it runs out. The frequency of the refills will depend on which drug concentration is used, the daily dose that's required and the pump size. It's similar to gas your car. You can only have so much in the system, so it needs to be refilled periodically; and how often it needs to be refilled just depends on your use. There are two pump sizes, a 2. ML and a 4. 0 ML. We encourage the larger size if possible so you won’t need to refill it as frequently. Your provider should help with considering which size is likely to work best for you. FDA regulations require that you get the pump refilled at least every six months, even if your pump is not yet empty. Refill frequency varies between 1 and 6 months. Reprogramming. You may need to get the dose or pattern of infusion adjusted periodically, especially when you first start with the pump. If you have an MRI, make sure you have an appointment to have your pump checked within two hours after to make sure the pump rotor has restarted itself after an expected stall because of the magnetic effect on the rotor. If the pump alarm goes off. Replacement. After about 5 to 7 years, your pump will need to be replaced with another surgery. When you have insufficient spasticity control using other options. When there are unacceptable side effects to oral medications. If you need a more precise dosing system to deal with fluctuations in your spasticity. Effectiveness. Intrathecal baclofen is generally very effective at reducing spasticity in the spinal cord injured population. Furthermore, this method has also provided additional benefits, including decreases in pain, bladder hyperactivity and time required for caregiving. Disadvantages, considerations, and complications. The system needs to be replaced about every 5 to 7 years. This time only the pump is replaced, so the surgery is less complicated than the first time. As with any surgery, there are potential surgical complications (bleeding, infection). It is far more expensive than using oral medications, although it may save money in the long run. There are potential complications related to the pump or catheter system or due to human programming errors. To reduce these rists, the user must have a good understanding of the warning signs of baclofen overdose and underdose, the ability to monitor these warning signs, good transportation in an emergency, and be vigilant in coming to scheduled refill appointments. Works best for treating leg spasticity rather than arm, hand, or upper trunk spasticity. Since spasticity can help people with standing, walking or transferring, taking away the muscle tone caused by your spasticity may reveal that you are weaker than you thought, and you might even lose some function if this occurs. Unfortunately, there is no way of knowing ahead of time if this might happen. A good rehabilitation or therapy assessment may help you think about how spasticity reduction may affect you.? The number 1 source of dissatisfaction with this therapy is having unrealistic goals for what intrathecal baclofen can do for you. Your provider has determined that you can benefit from intrathecal baclofen and that it is physically safe for you.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. Archives
December 2016
Categories |