Introduction
According to the Seven Brunnstrom Stages of Motor Recovery (Brunnstrom 1970), stroke patients go through stage of flaccidity to some spastic tone, marked spasticity and synergistic movements in the first 4 stages. At stage 5, spasticity fading with synergies gradually reduced and develop coordinated and complex movement and back to normal. However, it is the most challenging task for therapists to help stroke patients who have developed mark spasticity to revert to regain normal movement from adapted synergistic movements. Sunnerhagen et. al., 2016, reviewed some predictors of post stroke spasticity. Based on Neuro-IFRAH approach, Occupational Therapy in Kowloon Hospital has been working in previous years to prevent and reduce spasticity for patients with stroke. The application is from sub-acute to out-patient phases. It involve in/out patient phase patient and care taker education on handling and positioning for shoulder protection and spasticity risk factors, stratified treatment in early trunk control, facilitative upper limb training, application of flexor tone inhibitory splints and home programs.
Objectives
(1) To prevent and reduce severe spasticity development in stroke survivors. (2) To enhance better upper limb and self-care function for patients with stroke.
Methodology
A retrospective review of stroke outcome data from CDARS is compared for in and out patients in the period of 2016 to 2018. For cases who had received intensive OT training together with botox injection or TMS treatment by Rehab Specialist, a pre-test and post –test design was used to compare the efficacy of intervention in spasticity, upper limb function and self-care function.
Results & Outcome
The retrospective review of inpatient data showed significate different of Functional Independence Measurement (FIM) gain for stroke patients (p< 0.001) in 2014/15 (n=803) average gain is 8 while 2016 to 2018 (n=2869) FIM gain is 11.1. From 2016 to 2018 CDARS data, Functional Test of Hempilegic Upper Extremity (FTHUE) gained average 0.5 (in-patients), and average 2 (out-patients). The intensive OT anti-spasticity program was also collaborated with two intervention of TMS and Botox injection by our Rehab Specialist in Kowloon Hospital also reflected positive outcomes in terms of FTHU, FIM active, passive range of movement and spasticity.
Co-location with:
