Bloody Baclofen

Jo didn't answer her phone until 09:00. I rang her at 10:30 and she had just finished a session in the gym, where it sounds as though the neurological physiotherapist is finally giving her the right kind of physiotherapy, manipulating the muscles in her arm and leg to counteract stiffness and getting her to stand unaided, with a transfer, another milestone. Jo said she was very wobbly standing, which is to be expected, and the session had tired her out, also to be expected.

I spoke with the physiotherapist, who agreed the Baclofen was counter-productive and she would speak to the occupational therapist, who had prescribed the bloody things, to get her approval to stop them. This is the problem with OTs, they look at things the way they are now and work on the assumption that is what they have to deal with, rather than consulting with the physiotherapists, to see what they will have to deal with in the future.

Baclofen is a muscle relaxant medicine that works by binding to a receptor in the brain and spinal cord (central nervous system) called the GABA-B receptor. The effect of this is to "damp down" the signals sent to the muscles.

This makes it the wrong drug to be administering to Jo at this crucial stage and may even be a contributory factor in Jo not feeling her left leg once she had switched to it.

From the manufacturer's own literature, “Do not use Baclofen at a time when muscle tone is needed to assure safe balance and movement for certain activities.”

“Do not use this medication if you have a history of stroke or blood clots.”

I also spoke with the physiotherapist about a day visit for Jo and she agreed that we should aim to move Jo to the car by swivel.

I spoke to Jo about the transfer. She was not so positive as I was about it because she said when she transferred to her left leg she couldn't feel anything. I explained that this was the first step toward making the brain aware of that leg and so feeling it. Just making the brain switch to it was good.

Later on she complained of her bottom being sore. I asked which buttock.

“The right one.” She replied.

I told her to transfer her weight on to the left buttock, which she did, but said it just switched the pain from right to left. So I told her to alternate between the right and left buttocks continuously. This she also did and agreed that provided some relief. Then I pointed out to her that she was doing with her buttocks what she would soon be doing with her leg, that three weeks ago she had been unable to transfer her weight from right to left buttock, let alone feel it.

Sitting in the chair in the evening Jo's left foot was experiencing muscle pain, possibly due to the transfer earlier today. She moved the left foot up and to the right, a movement she was dimly aware of although she hadn't consciously initiated it.

We are fighting the negative effects of that bloody Baclofen, which has brought back the visual and spatial left side neglect. In the afternoon, while looking at a squirrel up a tree Jo could not see the branches protruding leftwards on the tree. When a patient's recovery depends on stimulating muscle control via the central nervous system you do not administer a drug that works by blocking muscle signals to the central nervous system. I have to question why the OT did not confer with the Neurological physiotherapist in making the decision to administer the bloody stuff.