Pumped Up by Treatment

Stroke Survivor Can Walk Again With a Cane

Following a stroke four years ago, Antonio Perez, 35, couldn’t stand for long and could only walk a few steps with the aid of a walker. It wasn’t for lack of trying or physical therapy. It was the spasticity in the muscles of his right leg and arm.

Spasticity is the involuntary contraction of muscles when the patient tries to move a limb. This creates stiffness and tightness. When a muscle can’t complete its full range of motion, the tendons and soft tissue surrounding it can become tight. This makes stretching the muscle much more difficult. If left untreated, the muscle can freeze permanently into an abnormal and often painful position.

Spasticity in the arm can cause a tight fist, bent elbow and arm pressed against the chest, interfering with a stroke survivor’s ability to perform daily activities such as dressing. Spasticity in the leg may cause a stiff knee, pointed foot and curling toes.

Such was the case for Antonio until a year ago when his doctor, NorthBay Healthcare neurologist Ameer Almullahassani, M.D., suggested a Baclofen pump.

Baclofen is a muscle relaxant usually given orally, but sometimes that dose isn’t strong enough to have much effect and increasing the dosage can cause drowsiness. Intrathecal Baclofen (or ITB) therapy uses state-of-the art technology to overcome that problem.

“We insert a (digital) pump under the skin and connect it to a small catheter that is fed into the spine,” explained Dr. Almullahassani. “Then we program the pump to provide continuous dosing. By injecting the drug right into the spine, it goes to the brain and you get a much better result without the drowsiness.”

The treatment is not for everyone. Before the pump is put in, a single dose of the drug is injected into the fluid around the patient’s spine. “Then we check to see if there is any improvement,” explained Dr. Almullahassani. “After these tests, most of the patients say they want it (the pump).”

That was the case for Antonio.

“Before the pump, I couldn’t really walk or stand because my leg was too stiff. Now I am doing better. I can stand and walk with just a regular cane,” he said.

“I would never have dreamed of this. You could see the change, right from the first test. At the time, my foot was basically pointed down and not going the right way. The Baclofen is straightening that out now.”

NorthBay began offering the ITB therapy a year ago with Dr. Almullahassani’s arrival. He praises the team approach at NorthBay. He works with a neurosurgeon to insert the pump as well as physical therapists, pharmacists and his medical assistant to coordinate the whole process.

Once the pump is in place, the dosage of the drug can be adjusted and thereafter the patient comes in every six months for a refill—a 5 to 10 minute office visit.”

“The only other thing for the patient to remember is that the pump is in there and they are going to set off metal detectors,” he added with a laugh.

For Antonio, who was the first NorthBay patient to get a pump, the device has made a huge difference. “When people see me, they can’t believe it,” he said.

“It makes my day when I see such improvement,” Dr. Almullahassani said. “The best time for me is when the trial test is a success and I hear from the family, ‘Wow, he’s able to move!’ Seeing the excitement in the patient is great. You are helping someone and that’s what my job is really all about.”

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