ITB ASSESSMENT

What primary condition is causing the patient's spasticity?






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Is the patient's spasticity generalized (in more than one extremity or muscle group)?


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Does the patient or caregiver find the patient's spasticity bothersome, painful, or impacting the patient's quality of life?


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Is the patient's spasticity severe, as in interfering with any of the following:

 
 
 
 
 
 
 
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Has the patient tried or currently receiving oral baclofen?


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Has the patient experienced intolerable side effects from oral baclofen?


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For full prescribing information of Lioresal® Intrathecal (baclofen injection), including BOXED WARNING, please refer to Lioresal® Intrathecal (baclofen injection) full prescribing information at www.lioresal.com/prescribinginformation.

See the device manual for detailed information regarding the instructions for use, the implant procedure, indications, contraindications, warnings, precautions, and potential adverse events. For further information, contact your local Medtronic representative and/or consult the Medtronic website at  www.medtronic.com.

For applicable products, consult instructions for use on www.medtronic.com/manuals. Manuals can be viewed using a current version of any major internet browser. For best results, use Adobe Acrobat® Reader with the browser.