gms | German Medical Science

Objectives/Interrogation: Spasticity in the upper limb has a significant impact on the patient's function. Management of patients inflicted with this condition demands care from across multiple disciplines. There is however little collaborative work process established for adultpatients. We aim to develop a comprehensive management for skeletally mature patients who developed upper limb spasticity in a coordinated multi-disciplinary team. Our treatment objectives are to improve patient's well-being through pain reduction, function optimisation, limb posturing reduction, and to prevent complications through early

Methods: An outpatient clinical care pathway involving the neurologist, hand surgeon, advance practitioner nurse, hand occupational therapist, medical social worker, pharmacist and dietician has been developed. Eligible patients are referred to the clinic following diagnosis and stabilization of inciting causes including cerebrovascular accidents, brain or spinal cord injuries and neurodegenerative disorders. Joint assessment by the different disciplines is performed in the same clinic session. Domains of evaluation included patient's general cognitive ability, condition specific pattern of neurological deficits, limb specific degree of spasticity and classification of limb function. A proposed algorithm based on contemporary evidence, techniques and available expertise is used by the team to suggest treatment options for patients and align management objectives with patients' expectations.

Results and Conclusions: Six patients have been reviewed under the proposed clinical pathway. There were 4 males and 2 females with mean of 62.9 years of age during the time of review. They were reviewed on average 279 days from the episode of inciting condition. The median number of activities of daily living (ADL) the patients could perform independently was 1.5 out of 6 prior to any treatment. Other patient outcomes and satisfaction will be collected before and after treatment.

We propose an outpatient clinical care pathway for adult patients suffering from spasticity of upper limbs. In view of the complexity of management in these patients, a treatment algorithm will lay out options available for patients, therapists and physicians to provide optimal care in line with current practices and patients' expectations.