Authors: (including presenting author): :
Lee T H (1), Eric Yeung MP (1), Yam CP (1) Kenneth Leung (2), Jocelyn Chan (2), Dora Chan (3), Delia Tsang (3), TAI Mei Lan (1)
Affiliation: :
(1) Department of Rehabilitation, (2) Physiotherapy Department, (3) Occupational therapy Department, Kowloon Hospital
Introduction: :
Limb spasticity is a common complication in patients after stroke and other neurological disorders that limit patients’ functional recovery and may result in various biopsychosocial negative impacts. Integrated Day Rehabilitation Center (IRDC) in Kowloon Hospital adopted a multidisciplinary and multi-modalities approach to help these patients. Local outcome data of spasticity management is scarce, and we report the demographics, clinical data, and outcomes of 33 patients with spasticity who were managed in Kowloon Hospital (KH) Spasticity Clinic and IRDC
Objectives: :
To evaulate the outcome of spasticity managment
Methodology: :
The clinical records of all patients with spasticity referred to the KH spasticity clinic and IRDC from April 1, 2022, to March 31, 2023, were reviewed retrospectively. Paired T-test was used while comparing the means of 2 groups of patients
Result & Outcome: :
In the above period, our center managed 33 patients with spasticity. The mean age was 54.6 ± 13.3 years old with male to female ratio was 22 to 9 (71% versus 29%). Most of the patients (n = 22; 71%) lived in residential homes after discharge from the hospital and the majority of them suffered from cerebral vascular accident (n =26; 83.9%), four patients (12.9%) suffered from head injury. Physiotherapy and occupational therapy were provided for all patients and the mean IRDC training session was 21, ranging from 7 -33. Oral anti-spasticity medications were prescribed in 23 patients (74.2%) and about half of patients (n =16, 51.6%) also received intramuscular botulinum toxin injection therapy. Eight patients (25.8%) underwent additional therapies such as repetitive transcranial magnetic stimulation(rTMS) and extracorporeal shock wave therapy (ESWT). After treatment, nearly all patients (n = 32, 97%) resulted in various degrees of functional improvement. The mean Barthel Index (BI) and Functional Independent Measure (FIM) score increased by 14.9 ± 3.6 and 15.3 ± 4.8 (p < 0.05) respectively. The Functional Test of the Hemiparetic Upper Extremity (FTHUE) and the Modified Rivermead Mobility Index (MRMI) increased by 0.6 and 5.1 respectively (p < 0.05). Our series found that up to 64.5% of the patients (n =19) had at least one grade improvement in ambulatory ability and there was an observed additive treatment effect as reflected by Modified Functional Ambulatory Category (MFAC) increments. There was no adverse intervention-related incident was found in our series. Conclusion Multidisciplinary and multi-modalities approaches are effective in spasticity management. Early diagnosis and referral to a rehabilitation center with a specialty support are paramount in helping those patients.
