Exploring Spasticity: Join Exploring Spasticity

Exploring Spasticity - Empowerment Through Community



	With Exploring Spasticity, you'll receive and have access to:

Stories from others with spasticity

Information on spasticity treatments

Physician Locator

Join Our Community

Exploring Spasticity is open to anyone whose life is affected by spasticity. This includes individuals with spasticity, their caregivers, children, or other family members and friends.

* Required questions must be answered


	If you are under 18 years old, permission of a parent or guardian is required.

How old are you?

18 or older

			Under 18
Name of parent or guardian granting permission is required:

* First Name

* Last Name

* Address

* City

* State

(Open to US residents only)

* Zip

* Age

* Email

Phone

1. Which of the following best describes you?

(Please select all that apply)

		I have spasticity (tight, stiff muscles)

		I am a family caregiver of someone with spasticity

		I am currently using intrathecal therapies1 to treat my severe spasticity

		Other:


	NOTE: If you are a family caregiver, please answer the following questions from the perspective of the person with spasticity.

2. Due to spasticity, how difficult is it for you to perform everyday activities such as moving comfortably, eating, walking, dressing, or sleeping?


		Not Difficult

		Somewhat Difficult

		Difficult

		Very Difficult

3. Please note the level of satisfaction with the current spasticity treatments.


		Very Satisfied

		Satisfied

		Dissatisfied

		Very Dissatisfied

4. The origin of the spasticity is most closely related to:


		Brain Injury

		Multiple Sclerosis

		Stroke

		Cerebral Palsy

		Spinal Cord Injury

		I am unsure

5. Please tell us if the individual living with severe spasticity is:


		Pediatric (Under 18)

		Adult (18+)

7. Have you and your doctor discussed intrathecal therapies as a treatment
for severe spasticity? If so, what steps have you taken?

(Please select all that apply)

		I have not yet discussed this treatment with my doctor

		I have undergone the screening test (test dose of the medication) and DID NOT have a successful response

		I have talked with my doctor about intrathecal therapies and she/he believes I am a candidate

		My doctor does not believe I am a candidate

		I have already reviewed information or researched this treatment option

		I am actively considering intrathecal therapies1 to treat severe spasticity

		I am just starting to learn about this treatment

		I am currently using intrathecal therapies1 to treat my severe spasticity

		I have undergone the screening test (test dose of the medication) and had a successful response

By completing this form, you are registering for the Exploring Spasticity program, which includes announcements about events, opportunities, and publications. This also includes future updates about Medtronic products or therapies related to severe spasticity. By submitting this form you are granting Medtronic permission to add your contact information to its database for Severe Spasticity and consent to receiving information and communications related to Medtronic products and therapies. You may revoke this permission at any time by emailing spasticity@medtronic.com or sending a request in writing to: Medtronic ITB Therapy, 7000 Central Avenue NE, RCE 240, Minneapolis, MN 55432-3576. Medtronic respects the confidentiality of personal information. We assure you we will not share your personal information, except as otherwise noted in our privacy policy.

1Intrathecal therapies use a surgically placed pump and catheter system to deliver drug directly to the intrathecal space where fluid flows around the spinal cord.