Concern over the development of tolerance in patients on continuous intrathecal baclofen therapy has arisen as this new form of treatment for spasticity has gained wider use. We have studied time-dose relationships in 18 spinal cord injured patients who have undergone intrathecal baclofen infusion pump implantation since February 1988 in our facility. Our data show that there was a significant increase in baclofen dosage needed to control spasticity during the first 12 months post implantation. After 12 months, however, no significant changes in dosage requirement was detected. In addition, there was no significant difference between completely and incompletely spinal cord injured patients with regard to both the initial dose and the tolerance trend.
A substantial portion of primary care physicians' offices are not in compliance with the ADA, and some informational tools will be required to inform physicians about the nondiscriminatory requirements of the statute.
This study shows that increased training time and consequent microtrauma associated with professional volleyball activity can increase the likelihood of de Quervain disease.
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