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Introduction When spasticity interferes with comfort, function, activities of daily living, mobility, positioning, or caregiver assistance, patients should be considered for intrathecal baclofen (ITB) therapy. Methods An expert panel consulted on best practices. Results ITB can be considered for problematic spasticity involving muscles/muscle groups during all phases of diseases, including progressive neurologic diseases. ITB alone or with other treatments should not be exclusively reserved for individuals who have failed other approaches. ITB combined with rehabilitation can be effective in certain ambulatory patients. ITB is also highly effective in managing spasticity in children, who may suffer limb deformity, joint dislocation, and poor motor function from spasticity and muscle tightness on the growing musculoskeletal system. Spasticity management often allows individuals to achieve higher function. When cognition is impaired, ITB controls spasticity without the cognitive side effects of some oral medications. Goal setting addresses expectations and treatment in the framework of pathology, impairment, and disability. ITB is contraindicated in patients with hypersensitivity to baclofen, which is rare, or active infection. Some patients with an adverse reaction to oral baclofen may be mistakenly classified as having an allergic reaction and may benefit from ITB. Relative contraindications include unrealistic goals, unmanageable mental health issues, psychosocial factors affecting compliance, and financial burden. Vascular shunting for hydrocephalus is not a contraindication, but concurrent use may affect cerebrospinal fluid flow. Seizures or prior abdominal or pelvic surgery should be discussed before proceeding to an ITB screening test. Conclusions ITB should be considered when spasticity interferes with comfort or function.

This chapter considers how historical and contemporary narratives can be used to interpret issues of educational organisation and leadership. The research on which it is based sought to understand academic freedom and institutional autonomy through a case study of Addis Ababa University (AAU) between 1950 and 2005. This 55 year period saw three markedly different political regimes: feudalism (1950–1974), socialism (1974–1991) and democratic federalism (1991–2005). Historical narratives must make sense of stories told over time. The stories told during this study included contemporaneous archival materials narrating the points of view of the different political regimes in power and the leaderships of AAU and the reflective narratives of academics, including the lead researcher, Amare, who had lived through these periods. The research asked whether or not academic freedom and autonomy were attainable in a context of mutual support: the university that was responsible to the state that supported and funded it but, at the same time, the university itself played a central role in national politics. The nature of relationships between university and state is complex. The requirements to be free and accountable at the same time create tensions, especially when viewed from the point of view of the different ideas of the university. More pragmatically, if the university depends on the state both for its funding and for defining its value in serving society, then also stating itself to be independent of that same state is unrealistic.