Three physiatrists, each with decades of experience with baclofen pumps, will review several case histories with decision points along the way. The final outcomes will be shared with more discussion at the end. The cases will include some rare complications or conditions, such as the use of intrathecal baclofen during pregnancy, plus more common encounters for which there are no current guidelines or standard of care. This not a mechanical trouble shooting exercise but would involve care planning, ethics, multidisciplinary interactions and patient/family education.