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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Upper limb surgery for non-communicative patients with severe spasticity: the role of the carer burden score

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  • presenting/speaker Claudia Gschwind - Royal North Shore Hospital, Department of Hand Surgery & Peripheral Nerve Surgery, St Leonards, Australia
  • Jayne Yeomans - Royal North Shore Hospital, Department of Physiotherapy, St Leonards, Australia

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-694

doi: 10.3205/19ifssh0904, urn:nbn:de:0183-19ifssh09040

Published: February 6, 2020

© 2020 Gschwind et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Severe upper limb spasticity (ULS) can lead to difficulties with personal care and hygiene. Washing, dressing, trimming nails can be painful, poorly tolerated and in cases of severe contracture nearly impossible.

Despite the high incidence of acquired brain injuries and subsequent ULS in developed countries, there are only a few papers demonstrating the benefits of upper limb surgery with regards to improved ease of care postoperatively in patients who are unable to communicate. The Carer Burden Score (CBS) has been used to document improved ease of care in patients with ULS after Botulinum Toxin injections into target muscles. We applied the CBS to our patients preoperatively and again once treatment was finalized to document improvement in ease of care.

Methods: The patient's main carer was asked to fill in the CBS preoperatively and once treatment was finalized. The CBS grades for activities - cleaning the axilla, dressing the patient, cleaning the palm and cutting the fingernails - according to the degree of difficulty encountered from 0 to 4.

The most common procedures performed were wrist fusion, superficialis to profundus transfer, and neurotomies of the deep branch of the ulnar nerve and motor branch of the median nerve. In many cases the intrinsic muscles had to be released.

We assessed 49 limbs with the CBS pre-operatively and after 3 months.

Results and Conclusions: In all cases we found a significant drop in the CBS, supporting our statements of improved ease of case post spasticity surgery.

Ease of care for patients with ULS can be improved by Botulinum Toxin injections, as shown by several studies. However, the effect of Botulinum Toxin lasts for about 3 months only. Surgery brings a more lasting effect in ease of care which should translate into long term reduction of health costs.