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.
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!

 

 

 

 

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/.

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.

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!

Small preview image of a spider graph linking to blog post

CPRN’s progress as a Learning Health Network is published!

The Cerebral Palsy Research Network’s progress as a Learning Health Network (LHN) has been published in the Journal for Pediatric Rehabilitation Medicine this past week.

Primary author Amy Bailes, PT, PhD, published a self-assessment from leaders in the Cerebral Palsy Research Network using a tool developed by Cincinnati Children’s Hospital called the Network Maturity Grid (NMG).[1] The NMG is used to detail the maturation of necessary infrastructure and processes to create learning networks (LNs).

Bailes’ publication, the fourth since the CP Research Network’s inception six years ago, provides a glimpse into future directions for the network’s development. It details a standardizing scoring rubric used to assess progress across six domains including:

  • Systems of Leadership
  • Governance and Management
  • Quality Improvement
  • Engagement of Stakeholders
  • Data and Analytics
  • Research

The results were tabulated and graphed to provide insights into progress in each domain and areas for improvement.

The CP Research Network’s leadership team amalgamated this analysis to identify key investments that will improve our network maturity over the next five years. Moving forward, these investments will be centered on leadership development, financial sustainability, quality improvement training, the capture of patient-reported outcomes, and enhancing the quality of data collection.

The purple cover of the Journal of Pediatric Rehabilitation Medicine has its title and graphics of children playing, a person in a wheelchair, walkers and helping hands inside of green, pink and orange circles.

The cover of the Pediatric Rehabilitation Medicine.

The Network will incorporate the NMG tool into annual planning. Investments will be measured over the course of a five-year strategic plan for 2021-2025.

Members of the professional and academic community can access the article online with a Journal subscription. Community members may download the original article (prior to revisions required by the editors) from our website.

A banner with MyCP Webinar Series, ‘What is a learning Health Network and why should you care?’ and a photo of Dr. Amy Bailes.

What is a Learning Health Network – and why should you care?

Amy Bailes, PT, PhD

Amy Bailes, PT, PhD

On Monday, June 21, at 8 pm ET, we invite you to tune in for our next MyCP Webinar, to discover why the Cerebral Palsy Research Network is working to become a learning health network and how doing so will enhance our efforts to improve health outcomes.

The webinar will be presented by Amy Bailes PT PhD, leader of the CP Research Network’s quality improvement initiatives. She will outline how learning networks – that often form a registry at their core – can quickly gather and share data that rapidly improve treatment experiences for patients.

During the 40 minute webinar, Dr. Bailes, a physical therapist and researcher at Cincinnati Children’s Hospital, will also outline the CP Research Network’s efforts to become a learning health network and how that ties in to clinical initiatives we already have underway.

“Taking the most effective practices from the best CP centers across the nation and spreading those practices in a systematic fashion, will have profound impact on the health of people with CP,” says Dr. Bailes. “This is how we should be caring for all people with CP.”

Learning health networks seek to improve outcomes through a combination of research and quality improvement (QI) initiatives. While some research studies can take years to complete and can require more time to affect a change in practice, QI initiatives can drive systemic change and bring results as early as six months.

“While QI cannot answer fundamental questions about treatment effectiveness or discover new therapeutic interventions, it can be used to dramatically improve health outcomes very rapidly,” says Paul Gross, President and Chief Executive Officer of CP Research Network.

Members of the community, clinicians and researchers interested in learning more about the CP Research Network’s drive to become a learning health network can tune in to the June 21 webinar by registering on the sidebar at the top (or on the MyCP Webinar Registration page).

A small preview image of a virtual meeting linking to blog post ‘Annual Conference Sparks Innovation and New Research Ideas’.

Annual Conference Sparks Innovation and New Research Ideas

Forty-five clinicians from 28 academic medical centers came together on Zoom last month for the Cerebral Palsy Research Network’s fourth annual investigator conference.

Marc Randolph, cofounder and original CEO of Netflix

The two-day online gathering featured keynote speaker Marc Randolph, the co-founder and first CEO of Netflix, who shared pearls of wisdom on decision-making and growth to our diverse audience of research leaders.

Participants, including clinicians from the National Institutes of Health, discussed a range of network studies, including the relevance of genetics in cerebral palsy diagnosis, and brainstormed potential new areas in dystonia research and building capacity to care for adults with CP. 

The meeting also enabled the CPRN team to define goals for an updated 2021-2025 strategic plan, including expanding leadership systems, ensuring financial sustainability, engaging community members, and strengthening research and quality improvement projects. 

“This year, we were able to make extensive use of breakout rooms for discussions and collaborations among smaller groups of investigators,” says CPRN President and Chief Executive Officer Paul Gross. “We were fortunate to have support from the Weinberg Family Center for Cerebral Palsy, making for smooth logistics.”  

Moving to a virtual format proved to be a successful venture with the format and progress of CPRN’s 2021 conference receiving praise from the attendees.

“It was great,” wrote Dr. Ed Hurvitz, chair of Physical Medicine and Rehabilitation at the University of Michigan. “The best Zoom meeting of the year for content, for career development, and being able to connect a bit with friends old and new.”

Paralympian, advocate, and community advisor Duncan Wyeth, also in attendance, remarked: “I have acquired more knowledge and insight over two half-days about my disability and potential system mechanisms to address that disability than at any other time in my life. This meeting gives me great hope and expectations for the countless individuals who will know an enhanced quality of life because of this learning network.” 

Thank you to everyone who gave their time for this important conference. It has set us on an excellent trajectory for 2021 and beyond. We greatly appreciate the commitment of our dedicated investigator team and all their hard work advancing the care of people with CP.