Annual Assembly

Interventional Spasticity Intensive: Case-Based Skills Training and Assessment



Please email info@aapmr.org if you would like to be placed on a waitlist for the stand alone course option. 

Wednesday, November 13
1 pm-5:30 pm  

Henry B. González Convention Center, Room 207A

In this valuable half-day precourse, you'll learn how to enhance and assess your clinical skills in managing patients with spasticity and related conditions. Attendees will rotate through several stations in a small group setting, be presented with cases, develop a treatment plan, and learn/demonstrate hands-on skills that are relevant to that case scenario. At the end of this course, you'll walk away with new skills in focal chemodenervation (botulinum toxin, nerve, and motor point blocks) and intrathecal baclofen delivery.


Course Directors and Faculty


  • Marilyn S. Pacheco, MD, FAAPMR
  • Thomas K. Watanabe, MD, FAAPMR  


  • Alberto Esquenazi, MD, FAAPMR
  • Reza Farid, MD, FAAPMR
  • Shivani Gupta, DO, FAAPMR
  • Monica Verduzco-Gutierrez, MD, FAAPMR
  • Sheng Li, MD, PhD, FAAPMR
  • Michael Munin, MD, FAAPMR
  • Andrea Toomer, MD, FAAPMR
  • Michael Saulino, MD, FAAPMR

A Word from the Course Directors

AA19_Marilyn Pacheco"People should attend this course because they want to develop their skills in managing simple and complex spasticity cases.  In this course, they would learn from experts in the field and be able to assess knowledge and then assimilate new ones."—Marilyn S. Pacheco, MD, FAAPMR

AA19_Thomas Watanabe"This is a unique opportunity for participants to assess and develop skills in managing spasticity in a small group, case-based format led by very experienced clinicians. A range of interventions are covered, including intrathecal baclofen, botulinum toxin chemodenervation and nerve/motor point blocks. Clinical and functional assessment will be described in the small groups, as well as direct demonstration and hands on participation of these techniques, including the use of ultrasound, EMG and electrical stimulation guidance." Thomas K. Watanabe, MD, FAAPMR

Learning Objectives

Upon completion of this course, participants will be able to:

  • Assess their ability to formulate a plan to address deficits related to the upper motor neuron syndrome for a given case scenario.
  • Assess their skills at using ultrasound, EMG and electrical stimulation guidance to perform focal chemodenervation techniques.
  • Assess their ability to perform an intrathecal baclofen pump refill and perform advanced ITB programming.

Who Should Attend?

Physiatrists who want to learn how to enhance and assess their clinical skills in managing patients with spasticity and related conditions.

It is recommended attendees having some experience with:

  • Evaluating and managing patients with upper motor neuron syndrome
  • Basic familiarity with the use of an ultrasound machine
  • Reasonable foundation in functional neuroanatomy of the upper and lower limbs

Exhibitors include:

Allergan_h_tm_c               IPSEN

medtronic_cmyk               Piramal

Saol logo FINAL 


Support of the Interventional Spasticity Intensive: Case-Based Skills Training and Assessment Preconference Course has been provided through educational grants (financial and in-kind) from the following companies in accordance with ACCME guidelines: Allergan, Inc., Cadwell Laboratories, Intronix, Ipsen Biopharmaceuticals, Inc., Konica Minolta, Medtronic, Merz USA, Natus, Philips, Saol Therapeutics.


Live Course Agenda


12 pm-1 pm                   Registration                                               

1 pm-1:10 pm                Introduction

1:10 pm-2:10 pm           Case-Based Training Session 1

2:10 pm-3:10 pm           Case-Based Training Session 2

3:10 pm-3:20 pm           Break

3:20 pm-4:20 pm           Case-Based Training Session 3

4:20 pm-5:20 pm           Case-Based Training Session 4

5:20 pm-5:30 pm           Questions/Take Away Points

5:30 pm                            Adjourn

Case-Based Training Stations


There will be 4 stations teaching on areas as described below. Participants will be placed in groups of up to 5 and rotate to each station.

Station 1.  Pump Programming

  • Perform a pump refill procedure
  • Perform a concentration change and programming a bridge bolus
  • Perform pump programming including dosing changes and changing to flex dosing
  • Discussing troubleshooting procedures for ITB therapy
  • Performing catheter access port aspiration
  • Performing a priming bolus

Station 2.  Ultrasound Guided Pump Refill & ITB Screening Test

  • Review the sonographic appearance of intrathecal delivery systems including identification of the reservoir access port, the catheter access port and an inverted pump
  • Describe 2 methods for ultrasound guided reservoir port access with particular emphasis on the maintaining a sterile environment
  • Perform an ultrasound-guided refill on gelatin model
  • Describe ITB test dose protocols including appropriate patient preparation
  • Review the relevant anatomy for execution of a lumbar puncture
  • Describe appropriate patient positioning for lumbar puncture performance including manual and fluoroscopic-guided approaches
  • Perform a lumbar puncture on a simulation model

Station 3. Improving Upper Extremity Function for Patient with Upper Motor Neuron Syndrome

  • Clinical evaluation of UE spasticity, function and range of motion
  • Evaluation of assessment and determination of appropriate goals.
  • Development of a focal chemodenervation plan; discuss risks and benefits
  • Demonstration of use of botulinum toxin (preparation of toxin, dosing, dilution, ultrasound, EMG and electrical stimulation guidance)
  • Discuss post-procedure management

Station 4. Improving Gait for Patient with Severe Spastic Hemiparesis

  • Evaluation of goals
  • Clinical evaluation of LE spasticity, gait deviations and ROM
  • Development of a treatment plan utilizing diagnostic and neurolytic blocks; discuss risks and benefits of interventions
  • Demonstration of nerve block (ultrasound and nerve stimulation guidance) and surface stimulation for nerve motor point blocks.
  • Discuss post-procedure management    


The American Academy of Physical Medicine & Rehabilitation is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation of Credit

The American Academy of Physical Medicine & Rehabilitation (AAPM&R) designates this live activity for a maximum of 4.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Academy Tested, Board Approved!

The 2019 Annual Assembly Preconference Courses have been approved by the American Board of Physical Medicine and Rehabilitation (ABPMR) for Maintenance of Certification® (MOC®) Part II Self-Assessment credit.  Attendees must complete a post-test to earn AMA PRA Category 1 Credits™, which will be commensurate with the number of CME available for each precourse.



Early-Bird (May 15-September 18)
 Regular (September 19- Onsite)
Member Pricing $395
Nonmember Pricing $550  $650