Interventional Spasticity Management Applications


Interventional Spasticity Management Applications

2021 Course Cancelled - 2022 Dates and Location TBD

This two-day course is an intensive, hands-on program that will elevate the attendee’s knowledge and skills in the evaluation and management of spasticity and other forms of muscle overactivity. Strategies to differentiate and identify patterns of presentation and different focal and regional interventions that include neurolytic agents, neurotoxins and intrathecal medications will be discussed. World class faculty will guide small groups during hands-on training sessions. Upon completion of this course, attendees should be capable of planning and executing these procedures with a higher degree of confidence and efficiency.

Directors and Faculty



Alberto Esquenazi, MD and Michael F. Saulino, MD, PhD


Kristin E. Caldera, DO
Reza Farid, MD
Nicholas A. Godby, MD
Shivani Gupta, DO
Kimberly Heckert, MD
Nicholas C. Ketchum, MD
Marilyn S. Pacheco, MD
Andrea P. Toomer, MD
Monica Verduzco-Gutierrez, MD
Thomas K. Watanabe, MD  

Learning Objectives

At the completion of this course, participants will be able to:

  • Identify and apply interventional techniques for management of upper and lower extremity spasticity patterns
  • Utilize ultrasound, EMG and electrical stimulation guidance to perform focal chemodenervation techniques
  • Identify and apply interventional techniques for management of spasticity with intrathecal baclofen therapy
  • Describe various imaging techniques to troubleshoot intrathecal delivery systems



Day 1

7:00am – 8:00am                   Registration / Light Breakfast Available

8:00am – 8:15am                   Welcome and Introduction
                                                  Alberto Esquenazi, MD and Michael F. Saulino, MD, PhD  

8:15am – 8:45am                   Incidence and Presentation Based on Diagnosis
                                                  Thomas K. Watanabe, MD 

8:45am – 9:45am                   Focal Interventional Treatment Considerations 

9:45am – 10:15am                 Case-based Discussion: Diplegic Cerebral Palsy Leading to Lower
                                                  Extremity Neurolysis
                                                  Reza Farid, MD  

10:15am – 10:30am               Break

10:30am – 11:00am               Case-based Discussion: Hemiplegic Stroke Leading to Upper Extremity
                                                  Marilyn S. Pacheco, MD                                                                               

11:00am – 11:30am               Case-based Discussion: Paraplegic Spinal Cord Injury Leading to
                                                  Intrathecal Baclofen Therapy 
                                                  Andrea P. Toomer, MD  

11:30am – 12:00pm               Case-based Discussion: Quadriparetic Multiple Sclerosis Leading to
                                                  Intrathecal Baclofen Disruption
                                                  Michael F. Saulino, MD, PhD    

12:00pm – 1:00pm                 Lunch

1:00pm – 2:00pm                   Hands-On Skills Training: Session 1

2:00pm – 3:00pm                   Hands-On Skills Training: Session 2 

3:00pm – 3:15pm                   Break

3:15pm – 4:15pm                   Hands-On Skills Training: Session 3

4:15pm – 5:15pm                   Hands-On Skills Training: Session 4

5:15pm – 6:15pm                   Adjournment/Networking Reception

Day 2

7:15am – 8:00am                   Light Breakfast Available

8:00am – 9:00am                   Hands-On Skills Training: Session 5

9:00am – 10:00am                 Hands-On Skills Training: Session 6

10:00am – 10:15am               Break

10:15am – 11:15am               Hands-On Skills Training: Session 7

11:15am – 12:15pm               Hands-On Skills Training: Session 8

12:15pm – 1:15pm                 Lunch

1:15pm – 3:00pm                   Focused Skills Training Sessions

3:00pm – 3:15pm                   Break

3:15pm – 4:45pm                   Focused Skills Training Sessions

4:45pm – 5:00pm                   Debriefing with Q&A

Hands-on Training Sessions

Day 1 afternoon and Day 2 morning will focus on:

  • Pump refill with visual / palpation techniques as well as drug preparation
  • Pump basic and advanced programming
  • Catheter port access with visual / palpation techniques
  • Lumbar puncture on a simulation model 
  • Ultrasound guidance for reservoir and catheter access port
  • Radiographic review of pump troubleshooting techniques
  • Upper and lower limb muscle identification focusing on commonly encountered patterns with simulated injections on simulation models
  • Ultrasound guidance for upper and lower limb muscle and nerve localization
  • Upper and lower limb nerve localization with electrical stimulation

Day 2 afternoon will feature two (2) focused training sessions. Attendees will select one to attend:

  1. Advanced lumbar puncture training with fluoroscopic and ultrasound guidance, and pump programming and refilling using a second system available in the market.

  2. Unusual chemodenervation and neurolytic techniques when severe deformities are present (toxin dilution and volume adjustment to optimize effect, motor point vs nerve block, individual finger flexor fascicles, and importance of toe flexors on gait improvement) and cervical dystonia treatment with ultrasound guided muscle identification and simulated injections.

Agenda Breakdown

  • Up to 15.25 AMA PRA Category 1 CreditsMOC approved! 
  • 6 dynamic lectures and case-based discussions
  • 11 hours of hands-on, diagnostic and interventional procedures


The American Academy of Physical Medicine and 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 and Rehabilitation (AAPM&R) designates this live activity for a maximum of 15.25 AMA PRA Category 1 Credits™.  Physicians should only claim credit commensurate with the extent of their participation in the activity. 

This course has been approved by the American Board of Physical Medicine and Rehabilitation (ABPMR) for a maximum of 15.50 Maintenance of Certification® (MOC®) Part II Self-Assessment credits. Attendees must actively participate and complete a self-evaluation at the conclusion of the course to earn MOC Part II credit.

Hotel Information

AAPM&R offers discounted rates for pre-course and Annual Assembly attendees at several area hotels.  Once registration for our #AAPMR21 opens, visit our Hotel and Travel Information section for secure links and complete contact information to book your stay directly with you desired hotel. Bookings need to be completed before October 11, 2021.  

Course Check-In

Course check-in will be November 9 from 7:00 am-8:00 am where course badges will be available. 


Light continental breakfast items and lunch will be served on both days of the course.


Attendees are encouraged to dress comfortably. Scrubs are not required.

Cancellation and Change Policy

All cancellations for the Interventional Spasticity Management Applications must be submitted in writing via email to or via mail postmarked by September 21, 2021 to: 

American Academy of Physical Medicine and Rehabilitation
Attention: Jose Lopez
9700 W. Bryn Mawr Avenue, Suite 200
Rosemont, IL 60018

We look forward to your participation! Please contact with any questions.


This course is Step 2 of the STEP Interventional Spasticity Certificate Program. To attend the course you must register for the full STEP program. A la carte registration for this course is not available. Click here to view program details and to register for the STEP program.