1. Introduction to the intrathecal baclofen best practices project Michael Saulino, MD PhD Physiatrist MossRehab Elkins Park

2. My Disclosures Speaker’s bureau and clinical investigator for Jazz Pharmaceuticals Speaker’s bureau and clinical investigator for Medtronic, Inc Clinical investigator for Mallinckrodt Consultant for SPR therapeutics NANS Board of Directors

3. Best practices disclosures Project supported by Medtronic External medical writer for assistance with manuscripts and abstracts Four manuscripts have been submitted and are under review with Neuromodulation

4. Objectives of the project

5. Target Audience Clinicians who participate in the decision making regarding spasticity management and/or Clinicians who are involved in the management of ITB Therapy Meant to serve the broadest community possible – not just expert center

6. Expert work group Project Leaders: Aaron Boster, Linda Krach (initially) and Michael Saulino (subsequently) Bold Name represent section leaders Patient SelectionScreening TestLong term managementTroubleshooting Michael SaulinoSue BennettRoy AdairDavid Anderson Cindy IvanhoeGerald BilskyJudy GoochJennifer Doble John McGuireMark GudesblattMary E. NelsonReza Farid Barbara RidleyStephen KoelbelAndrea ToomerFatma Gul Jeff ShiltMaura McManusJoe UrquidezPeter Konrad

7. Expert work group Disciplines represented: PMR, neurology, neurosurgery, orthopedics, physical therapy and nursing Adults and peds Urban, suburban and rural practices Represent several hundred years of clinical practice and several thousand individual patient expereinces

8. What is a “Best Practice” Set of recommendations the based on the best available evidence and expert opinion Should not be considered the standard of care or minimum requirement for an intrathecal baclofen program Must always be considered in the framework of local environment