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Case Study 2 – Spasticity

Spasticity Management Clinic

Gillian Harte

Gillian is a Clinical Specialist Physiotherapist working within the Stroke Service at Tallaght University Hospital. She holds a BSc in Physiotherapy from the Royal College of Surgeons in Ireland (RCSI) and an MSc in Neurological Rehabilitation from the University of Plymouth, and works primarily in stroke rehabilitation.

Introduction:

Spasticity is a condition of disordered muscle function as a result of an upper motor neuron lesion. Untreated it can lead to a host of complications such as pressure ulcers, contractures, pain and progressive decline in functional ability.  Clinical Practical guidelines recommend that this condition should be appropriately managed within a specialised service to prevent complications.

Methodology:

There was no dedicated spasticity management clinic in TUH departments despite large stroke and neurology departments. This placed patients at risk of complications with increased risk of hospitalisation and A&E presentation, and limited the effectiveness of therapy, prolonging hospital stay. The Meath Foundation provided a grant to employ a part- time clinical specialist physiotherapist for six months.

Referrals were accepted for patients under the care of a Tallaght University Hospital Consultant or within the catchment area. Initial assessments included assessment of spasticity and functional implications. Treatment pathways were agreed and a procedure developed.

Patient Goals

Patient Goals: •28% of patients wanted to improve their mobility. •28% to improve passive function. •22% to reduce involuntary movement. •12% to reduce their pain. •6% to regain active arm function
  • 28% of patients wanted to improve their mobility.
  • 28% to improve passive function.
  • 22% to reduce involuntary movement.
  • 12% to reduce their pain.
  • 6% to regain active arm function.

Clinical Interventions

  • 73% of Patients were given Botox.
  • 11% given specific advice to patient and treating physiotherapist.
  • 8% of Patients were given an exercise programme.
  • 1% had advice sent to their GP.
  • 1% were referred to a TUH Consultant.

Outcomes after Botox

Outcomes after Botox: •62% reported that their goal was achieved. •23% reported that their goal was exceeded. •8% reported that their goal was not achieved. •7% reported that their goal was partially achieved.
  • 62% of patients reported that their goal was achieved.
  • 23% reported that their goal was exceeded.
  • 8% reported that their goal was not achieved.
  • 7% reported that their goal was partially achieved.

Did the Patients feel listened to by staff?

Did the Patients feel listened to by staff? •96% said ‘Yes, definitely’. •4% said, ‘Yes, somewhat’.
  • 96% said ‘Yes, definitely’.
  • 4% said, ‘Yes, somewhat’.

Patients were asked if they felt there was a clear plan for their care after visiting the clinic?

Patients were asked if they felt there was a clear plan for their care after visiting the clinic? •79% said, ‘Yes, definitely’. •17% said, ‘Yes, somewhat’. •4% said, ‘No’.
  • 79% said, ‘Yes, definitely’.
  • 17% said, ‘Yes, somewhat’.
  • 4% said, ‘No’.