Advanced Tone Management Multidisciplinary Clinic

The Advanced Tone Management (ATM) Multidisciplinary Clinic at CHOP is for patients with difficult-to-manage tightness of muscle tone and reduced capacity of the muscle to stretch. This can manifest itself as spasticity (when a person’s muscles contract and stiffen), dystonia (when a person's muscles contract uncontrollably) or a combination of the two. The ATM Clinic assesses children and adolescents for possible surgical interventions.

Who we are

The ATM Clinic consists of a group of specialists with expertise in multidisciplinary care for pediatric patients with increased tone. The multidisciplinary team includes members from rehabilitation medicine, neurology, neurosurgery, physical therapy, occupational therapy, nursing and social work.

What we do

The ATM Clinic offers single-day visits during which patients and their families can see all providers on the same day. We assess individuals for the appropriateness of surgical interventions to treat the individual’s tone or spasticity that may be interfering with activity, comfort or care. Potential procedures include:

  • Intrathecal baclofen (ITB) therapy: A pump delivers a medication called baclofen to the spinal canal. The baclofen pump is surgically implanted near the abdomen, with a catheter (a thin flexible tube) running to the spinal canal to deliver the medication.
  • Selective dorsal rhizotomy (SDR): a surgical procedure performed on the lower spinal nerves to reduce spasticity in the legs of children who have one of the spastic forms of cerebral palsy.
  • Deep brain stimulation (DBS): A battery-powered stimulator is implanted in the chest or abdomen and connected to thin leads in the brain to deliver electrical pulses that reduce dystonia symptoms.

We work to ensure appropriate and comprehensive care management.

Who we treat

Spasticity or increased tone in children and adolescents may be the result of a variety of conditions, including cerebral palsy, traumatic brain injury, spinal cord injury, cerebral malformations, and a variety of inherited conditions, such as leukodystrophy and other degenerative disorders. The ATM Clinic is available to any patient who has spasticity that is not responsive to oral medications or who is experiencing unwanted side effects from medications. The clinic is open to patients whether or not they are already seen by a doctor in the CHOP system.

If you, your child’s provider or your child’s therapist believe your child would benefit from the ATM Clinic, please contact our clinic coordinator at 215-590-7434.