Webinar: Intrathecal Baclofen Pump Complications

Robert Bollo, MD, with a shaved head and a smile, in a dark suit, white shirt and red striped tie

Dr. Robert Bollo will present on the CP Research Network’s efforts to reduce the most common complication with intrathecal baclofen pumps.

Our next MyCP webinar is Thursday, January 27, at 8 PM ET and will be about our efforts to improve outcomes for intrathecal baclofen pumps (ITB). ITB pumps are commonly used to treat spasticity in people with cerebral palsy. Our featured speaker will be Robert Bollo, MD, a pediatric neurosurgeon from the University of Utah. The webinar and open Q&A with Dr. Bollo will last one hour.

Dr. Bollo will present an overview of the use of ITB pumps in the management of spasticity and common post-surgical complications with ITB pumps. He is leading a quality improvement (QI) initiative (study to improve outcomes) in the CP Research Network to monitor the most common complication of baclofen pumps – post surgical infections. ITB pump infections are common but estimates of infection rates in the literature vary widely with an average of 10%[refs] of all implantations.

Interested participants need to register in advance. Members of the MyCP webinar series will be emailed a link for this webinar. It is free and open to the public. It will also be recorded for future viewing.


References

  1. Fjelstad AB, Hommelstad J, Sorteberg A. Infections related to intrathecal baclofen therapy in children and adults: frequency and risk factors. J Neurosurg Pediatr. 2009 Nov;4(5):487-93. doi: 10.3171/2009.6.PEDS0921. PMID: 19877786.
  2. Tyack L, Copeland L, McCartney L, Waugh MC. Adverse events associated with paediatric intrathecal baclofen in Australia: 5 years of data collection. J Paediatr Child Health. 2021 Feb;57(2):258-262. doi: 10.1111/jpc.15194. Epub 2020 Sep 25. PMID: 32975337.
  3. Imerci A, Rogers KJ, Pargas C, Sees JP, Miller F. Identification of complications in paediatric cerebral palsy treated with intrathecal baclofen pump: a descriptive analysis of 15 years at one institution. J Child Orthop. 2019 Oct 1;13(5):529-535. doi: 10.1302/1863-2548.13.190112. PMID: 31695821; PMCID: PMC6808077.
  4. Desai VR, Raskin JS, Mohan A, Montojo J, Briceño V, Curry DJ, Lam S. A standardized protocol to reduce pediatric baclofen pump infections: a quality improvement initiative. J Neurosurg Pediatr. 2018 Apr;21(4):395-400. doi: 10.3171/2017.10.PEDS17248. Epub 2018 Jan 26. PMID: 29372853.
  5. Desai VR, Raskin JS, Mohan A, Montojo J, Briceño V, Curry DJ, Lam S. A standardized protocol to reduce pediatric baclofen pump infections: a quality improvement initiative. J Neurosurg Pediatr. 2018 Apr;21(4):395-400. doi: 10.3171/2017.10.PEDS17248. Epub 2018 Jan 26. PMID: 29372853.
  6. Spader HS, Bollo RJ, Bowers CA, Riva-Cambrin J. Risk factors for baclofen pump infection in children: a multivariate analysis. J Neurosurg Pediatr. 2016 Jun;17(6):756-62. doi: 10.3171/2015.11.PEDS15421. Epub 2016 Feb 26. PMID: 26919315.
  7. Haranhalli N, Anand D, Wisoff JH, Harter DH, Weiner HL, Blate M, Roth J. Intrathecal baclofen therapy: complication avoidance and management. Childs Nerv Syst. 2011 Mar;27(3):421-7. doi: 10.1007/s00381-010-1277-9. Epub 2010 Sep 18. PMID: 20853002.
  8. Motta F, Antonello CE. Analysis of complications in 430 consecutive pediatric patients treated with intrathecal baclofen therapy: 14-year experience. J Neurosurg Pediatr. 2014 Mar;13(3):301-6. doi: 10.3171/2013.11.PEDS13253. Epub 2014 Jan 3. Erratum in: J Neurosurg Pediatr. 2014 May;13(5):588. PMID: 24404968.
  9. Borowski A, Littleton AG, Borkhuu B, Presedo A, Shah S, Dabney KW, Lyons S, McMannus M, Miller F. Complications of intrathecal baclofen pump therapy in pediatric patients. J Pediatr Orthop. 2010 Jan-Feb;30(1):76-81. doi: 10.1097/BPO.0b013e3181c6b257. PMID: 20032747.
  10. Gooch JL, Oberg WA, Grams B, Ward LA, Walker ML. Complications of intrathecal baclofen pumps in children. Pediatr Neurosurg. 2003 Jul;39(1):1-6. doi: 10.1159/000070870. PMID: 12784068.
A headshot of Lily Collison with short, dark hair, the cover of Pure Grit and blond haired Kara Buckley

Pure Grit: An interview with the authors

Ila Eckhoff with tight curly brown hair smiles broadly with dark glasses and a light blue fleece over her v-neck shirt.

Ila Eckhoff, is a managing director at Blackrock Associates and is featured in Pure Grit.

The Cerebral Palsy Research Network will kick off its 2022 MyCP webinar series with an interview of the authors of Pure Grit, a book full of stories about remarkable people with physical disabilities doing extraordinary things.  The webinar is free and open to the public next Tuesday, January 11 at 8 pm ET. Ila Eckhoff, an accomplished financial services sector leader and one of the featured people in the book, will also join the conversation with authors Lily Collison and Kara Buckley.

The interview will include how the authors sought to develop the book, chose their subjects, and what they hoped the book would achieve. The one hour webinar will include 40 minutes of interview followed by open Q&A with the attendees.

Please join us for the interview.  If you are not already registered for the MyCP Webinar Series, you can sign up here.  A free Zoom account is required to sign into the webinar.  We look forward to seeing you there.  If you cannot make it, the interview will be recorded and posted on our YouTube channel within 24 hours.

Happy New Year 2022 from the CP Research Network with a black background and fireworks in the corners

Happy New Year from the CP Research Network

At the Cerebral Palsy Research Network, we have a lot to be thankful for.  You, our great extended cerebral palsy (CP) community, helped us achieve our fundraising goal of $10,000 this past month for our MyCP webinar series in 2022.  With our board of directors’ matching, we raised more than $30,000 for our network! We are excited to bring our MyCP webinar series back in full swing next week beginning with a live interview of the authors of Pure Grit (details to come out tomorrow).  Thank you to all who contributed and helped to spread the word!

2021 in Review

Last year was transformative in numerous ways for the CP Research Network.  We kicked off the year with the announcement of our merger with CP NOW. The combination of their educational and wellness programming with our efforts led to significant accomplishments including:

 

Our Research and Quality Improvement initiatives made significant progress in both seeking to answer key research questions about CP and improving the treatment of people with CP now.  A few highlights include:

What’s new for 2022?

We have a lot of projects that will culminate in 2022! These include multiple publications of our work in leading journals, partnerships to sustain and grow our wellbeing offerings, continued progress on our research and quality initiatives, and the return of our MyCP webinar series to name a few.

There are lots of ways to stay engaged with us.

Please consider one of these:

All the best to you and the entire CP community for 2022!

 

 

 

 

Cerebral Palsy Fitness program gets sponsorship from Neurocrine Biosciences

Neurocrine Biosciences Sponsors Cerebral Palsy Fitness

Neurocrine Biosciences logo

Neurocrine Biosciences is the exclusive sponsor of our MyCP Fitness program with Staying Driven.

The Cerebral Palsy Research Network announced that Neurocrine Biosciences, a pharmaceutical manufacturer based in Southern California, will be sponsoring the network’s MyCP Fitness Program hosted by Staying Driven. The CP Research Network launched its MyCP Fitness program in June 2021 to enable members of the MyCP community to have access to quality adaptive fitness from the safety and comfort of their own home. The network chose adaptive fitness coach Steph “the Hammer” Roach and her crew of adaptive fitness trainers to provide these free services to our community. The Neurocrine sponsorship enables us to continue the program through 2022.

While physical activity is important for everyone’s health, it has been shown to be even more important for people with disabilities like CP who are at greater risk for cardiometabolic disease.[ref] The challenge is that most gyms or virtual fitness programs don’t have appropriate accommodations or adaptations for people with CP. Staying Driven, founded by Steph Roach, a former CrossFit trainer who has CP, focuses on fitness for people with disabilities. Our program was an attractive fit for Neurocrine which has a philosophy is to holistically support and be good partners to the patient community they hope to serve.

The Neurocrine Biosciences sponsorship not only extends the length of the program, but enables the CP Research Network to reach more community members. Teens and adults with CP who are interested in participating in the MyCP Fitness program can sign up for free on our Cerebral Palsy Fitness page.
Dr. Bhooma Aravamuthan, pictured in a white lab coat and dark rimmed glasses, will speak about dystonia in CP

Update on Dystonia in Cerebral Palsy

On Thursday, December 9, at 8 pm ET, the CP Research Network will hold its final MyCP webinar for 2021 to provide an update on our work in dystonia in cerebral palsy. Bhooma Aravamuthan, MD, DPhil, a pediatric movement disorders neurologist at St. Louis Children’s Hospital, and a leader in the network, will present an update on our progress in this important area of research and care.

In 2019, the Cerebral Palsy (CP) Research Network started an effort to build a community centered research agenda for dystonia in CP. Dr. Darcy Fehlings had found that dystonia was significantly under diagnosed in the CP population and that as much as 80% of the people with CP had some degree of dystonia in addition to spasticity.[ref] The presence of dystonia can be challenging and painful for people and often requires different approaches to treatment. Parents expressed frustration in getting an accurate diagnosis that allowed their children get relief from these symptoms. The CP Research Network developed Research CP Dystonia Edition to engage the extended community – caregivers, people with CP, and clinicians – in a dialogue about the most pressing issues needing research in dystonia in CP.

Dr. Aravamuthan leads our quality improvement effort focused on increasing practitioner awareness of dystonia screening for every person with CP. She will describe how this effort addresses a key priority set forth in Research CP Dystonia Edition. She will also describe research concepts that she is developing to directly engage the community to advance dystonia diagnosis. Please join us for the webinar next Thursday evening by signing up at https://cprn.org/mycp-webinar-series/.

A blond woman kneels while speaking with her daughter braided hair in a wheelchair.

Results: Communication and Participation in CP

Kristen Allison, PhD, CCC-SLP. A smiling woman with long blond hair wearing earrings and a light grey sweater.

Kristen Allison, PhD, CCC-SLP, an Assistant Professor at Northeastern, is this month’s featured speaker for the MyCP Webinar Series, presenting the results of her recent study in speech and language for children with CP.

Next Wednesday, November 17, at 8 pm, Kristen Allison, PhD, CCC-SLP, will present the results of her study of Speech and Language Predictors of Participation in Children with Cerebral Palsy, as part of the CP Research Network’s MyCP Webinar series. Dr. Allison received our Research CP grant award in 2019 for her study investigating how speech and language capability affect a child’s quality of life in terms of participation in activities. Attendees of this webinar will learn what she discovered and be able to participate in a live Q&A with Dr. Allison.

“We found that several aspects of a child’s speech and language skills affect how often they participate and how involved they are in social activities.” said Dr. Allison. “Our results highlight just how important effective communication is to quality of life for children with CP!”

Dr. Allison is an Assistant Professor in the Department of Communication Sciences & Disorders and the director of the Speech Motor Impairment & Learning (SMILe) Lab at Northeastern University. The study was hosted and distributed through th CP Research Network Community Registry and data collection was completed in 2020. Dr. Allison will not only share the results of the study but talk about its meaning for both parents of children with CP, but also how the data will be used to inform future research questions.

Community members interesting in learning about the results of Dr. Allison’s research can sign up to receive webinar login instructions. People who have already registered for the whole MyCP webinar series will be sent an invitation with login details prior to the webinar. Note: Our MyCP webinar series now require a Zoom account to sign in. You can get a free Zoom account here.

The MyCP webinar on assessing pain in adults with CP will be delivered by Drs Gannotti and Noritz

Assessing Pain for Adults with Cerebral Palsy

Drs. Gannotti and Noritz, dressed in business attire, at an informal meeting in Austin, TX

Drs Gannotti and Noritz, clinicians who treat both children and adults, will present on assessing pain in adults with cerebral palsy (CP).

This month’s MyCP webinar will focus on the CP Research Network’s Adult Care quality improvement (QI) initiative at 8 pm ET on Monday, October 25. CP Research Network leaders Garey Noritz, MD and Mary Gannotti, PT, PhD, will provide an overview of this initiative which is focused on pain for adults with CP. Quality improvement, like clinical research, is aimed at improving health outcomes but using a different methodology to achieve those outcomes. QI is exciting because it can change health outcomes much more rapidly than clinical research. The webinar will include a brief overview of how QI enables these faster changes in outcomes.

Our Adult Care QI initiative includes clinicians that treat adults with CP and community advocates working together with a global aim of improving the care that adults with CP receive. Supported by data from our Adult Wellbeing and Chronic Pain study, this initiative has narrowed it first efforts to uniformly assess pain in each clinic visit for adults with CP. In addition to support from our ongoing study, a recent MyCP focus group with several adults with CP helped shape initial assessments of pain used by the participating clinicians.

Dr. Gannotti is a professor of physical therapy at the University of Hartford and a PT affiliated with Shriners’ Hospital of Springfield and co-leads the adult study group of the CP Research Network. Dr. Noritz is the Director of the Complex Care program at Nationwide Children’s Hospital and an adult internist who treats adults with CP. Doctors Gannotti and Noritz will present for approximately 25 minutes before opening the webinar to questions and answers. Community members who wish to participate in the webinar can sign up on CPRN or to receive an email with a link to the recording after the webinar.

October 6 is World CP Day - Millioins of Reasons to Spread the Word

CP Research Network Featured at AACPDM

The Cerebral Palsy Research Network was invited alongside of the National Institutes of Health (NIH), the Patient Centered Outcomes Research Institute (PCORI), and C-Progress to teach early-stage investigators how to establish a successful research program at their institution during the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM). The nine-hour pre-conference tutorial featured presentations from each of these research and funding organizations to emphasize key steps for an investigator to get funding. The CP Research Network is differentiated from its co-presenters by being an organization that facilitates and conducts research.

In addition to presenting the network’s programs, registries, and tools, CEO Paul Gross held a breakout session for Q&A with interested attendees. “It was an honor to present our mission and vision alongside the largest public funders for research – NIH and PCORI,” said Gross. “The attendees also heard from Dr. Michael Kruer about his experience working with the CP Research Network to gain $3M in funding from NIH for his genetic causes of CP study.”

This pre-conference session fell on October 6 – World CP Day – when the CP Research Network Board of Directors has offered to match donations two-fold! World CP Day creates awareness about CP and much needed research around the globe. We are excited to be part of accelerating that research by educating new investigators to the field.

A green page banner with a headshot of Dr. Wade Shrader. A smiling man with short brown hair and beard wearing a dark suit.

Webinar on Hip Surveillance and CP

Dr. Wade Shrader of Nemours/AI duPoint, smiling in a blue suit, is an orthopedic surgeon who leads the CP program at Nemours

Dr. Shrader, an orthopedic surgeon, leads the hip surveillance initiative for the CP Research Network.

After taking a break during the last month of summer, our MyCP webinar series will resume on Wednesday, September 29 at 8 pm ET with a presentation on our hip research program. Hip pain is the most frequent cause of pain in children with cerebral palsy and can cause problems with mobility and range of motion. We have begun a hip surveillance program at our the CP Research Network centers to proactively address this issue—a very challenging task to undertake. Our upcoming webinar will feature Dr. Wade Shrader, a pediatric orthopedic surgeon and Division Chief of Cerebral Palsy at Nemours/AI duPont Hospital in Wilmington, DE who leads this effort for the network. He is also the parent of four children, two of whom are adults with CP.

In order to protect the hips of children with CP, the American Academy for Cerebral Palsy and Development Medicine (AACPDM) released an updated “care pathway” recommending the frequency and techniques for monitoring the hip health of children with CP in June 2018. Care pathways combine the latest evidence-based medicine and expert opinion to provide guidance on how to treat complex conditions. Dr. Shrader will discuss the anatomy of childrens’ hips, the impact of CP, the importance of monitoring hips, and how parents and caregivers can advocate for their child’s hip health.

“I know first-hand as a Dad how tough recovery from hip reconstruction surgery can be, “ said Dr. Shrader. “I’m looking forward to talking with the CPRN community about hip issues in Cerebral Palsy, and to give my perspective as both a pediatric orthopedic surgeon and a family member.”

Community members and clinicians interested in the webinar can sign up on cprn.org. MyCP members and series registrants will receive the Zoom link automatically prior to the webinar. Join us!

A scene from Hawaii with two palm trees standing in a lush green field with the ocean beyond and a perfect rainbow behind them.

Caregiver Mental Health: The Importance of You

“You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You must do the things which you think you cannot do.” — Eleanor Roosevelt

Caregivers often put their entire heart and soul into the care they give others. For most being a caregiver was never a choice, more so a job taken on with determination and courage. Taking care of any child requires time, patience, understanding, love, and an immense amount work. When adding a child with a disability into the equation these requirements are greater. As a caregiver, it is important to take time for self-care. When caring for others it is important that you also take care of yourself.

A lush, living wall of greenery with neon sign that says "breathe" in script with a pale pink written at a 45 degree angle

Focusing on your breathing, an essential step in meditation, is a great way to calm your mind.

Parents/Caregivers face uncertainty and anxiety particularly as they adjust to their new caregiving roles. Arranging healthcare providers, keeping up with day-to-day needs, and making major medical decisions are just a few areas of concern ]caregivers have. All these tasks, and more, require a great deal of time and patience. Unfortunately, many caregivers get lost in the process.

Some parents find the needs of the child so overwhelming that they neglect their own health, either because it seems insignificant or because it is too costly to eat well and get proper rest and respite from caregiving responsibilities.
Freeman Miller, M.D.
Pediatric Orthopedic Surgeon

Therefore, it is so important as a caregiver to identify symptoms of ongoing stress that may lead to anxiety or depression. Taking time for self-care and seeking professional guidance and counseling can mitigate and prevent caregiver burnout.

What do anxiety symptoms look like for caregivers? (ADAA, 2020)

  • Constant fearfulness, worry or impending doom and excessive sweating
  • Trouble eating or eating too much
  • Shortness of breath that keeps coming back
  • Sleep problems and irritability
  • Heart racing or beating hard in the chest

What do depression symptoms look like for caregivers? (ADAA, 2020) Depression for anyone can vary in symptoms. When looking at symptoms directly related to caregivers here are some things to consider:

  • Avoiding pleasurable or meaningful activities because you feel guilty about taking time off from caretaking
  • Repetitive nightmares or intrusive thoughts about the patient/loved one, including the diagnosis, treatments, or future prognosis
  • Inability to sleep (with falling asleep or sleeping too much)
  • Feelings of exhaustion, severe tiredness
  • Feelings of tension and chronic irritability
  • Inability to concentrate or remember details
  • Anxiety attacks about not properly following the medical regimen
  • Inability to talk to others about your experience as a caretaker
  • Anticipatory anxiety about future treatments for the patient/loved one
  • Thoughts of suicide because you feel so overwhelmed, worthless, or inadequate

A lush, living wall of greenery with neon sign that says "and breathe" in script with a pale pink written at a 45 degree angle

Focusing on breath going in and out can help bring about a more calm state.


Practical self-care tips:

Self-care encompasses many different things-some that many may have not considered. It can be a nice bath, or a hot shower, a walk around the neighborhood alone, or even a glass of their favorite beverage. If the activity is done with intention and is enjoyable it can be a form of self-care. Eating well and getting good sleep whenever possible can help prevent periods of burnout and severe drops in mood (Marilynn, 2018).

Caregivers are hard on themselves; they have a huge job to do. Sometimes the inner voice that whispers to always ‘do better’ needs to be muted. The self-critical voice has to be stopped for a louder self-compassionate one to emerge (Marlynn, 2018).

Another thing great for relaxation and self-care practices are breathing exercises (Marlynn, 2018). Deep breathing techniques done for only 5-10 minutes a day can help recenter the mind. Accompany these exercises with positive affirmations and conscious instruction to get the best results.

Affirmations can start with ‘I am’ and include statements like:

I am enough. I am worthy. I am a good caregiver. I am a great parent. I am capable.

Instructions that you speak aloud to yourself can look like:

I breathe in calm and relaxing energy.

I pause to let the quite energy to relax my body.

I breathe out and release any anxious or tense energy.

*Breathing exercises should never be painful or uncomfortable. Remember to always only do what is comfortable for you and modify exercises it to better suit your individual needs.

Other relaxation exercises can include yoga, tai chi, guided meditations, hypnosis, and progressive muscle relaxation. We live in a world where the internet offers plentiful resources where we can find a lot of information. Use the internet to help you find local programming or relaxation tools/apps or, seek the support of a licensed counselor/physician

Social support is also another important part of self-care. Caregivers do not have to take on everything alone; try and connect with people who are willing to help and support you. Take time to spend a day with friends. Join a support group whether it be online or through a community program. The Cerebral Palsy Research Network has an online forum with groups spanning many different topics.

It is important to realize when you or someone you know needs help outside of family support. Talk to a healthcare provider if you are struggling. Asking for help is okay! Remember to take care of others properly you must take care of yourself!

Friendship Line: 800-971-0016

National Suicide Prevention Lifeline: 800-273-8255 (TALK)

SAMHSA: 800-662-4357 (HELP)

Samaritans: 877-870-4673 (HOPE) (call or text)

Crisis Text Line: Text “HOME” to 741741

Veterans Crisis Line: 800-273-8255 (press 1) or Text 838255

References

Caregiver mental Health: Anxiety and Depression Association of America, ADAA. Caregiver Mental Health | Anxiety and Depression Association of America, ADAA. (n.d.). https://adaa.org/find-help/by-demographics/caregivers.

Marlynn Wei, M. D. (2018, October 17). Self-care for the caregiver. Harvard Health. https://www.health.harvard.edu/blog/self-care-for-the-caregiver-2018101715003.

Miller, F., & Bachrach, S. J. (2017). Cerebral palsy: a complete guide for caregiving (3rd ed.). Johns Hopkins University Press.

Stiles, K. (2021, April 23). Depression hotline numbers. Psych Central. https://psychcentral.com/depression/depression-hotline-numbers#hotline-numbers.