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ID: <

10670/1.bexcbv

>

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DOI: <

10.26226/morressier.5cb58cecc668520010b561c2

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SPASTICITY-REDUCING HAND SURGERY: IMPROVED FUNCTION, ACTIVITY AND PATIENTSu2019 SATISFACTION AT ONE-YEAR FOLLOW-UP

Abstract

Spasticity-reducing hand surgery: improved function, activity and patientsu2019 satisfaction at one year follow-upUlla Bergfeldt RPT PhD, Joakim Stru00f6mberg MD PhD, Therese Ramstru00f6m OT, Katarzyna Kulbacka-Ortiz MSc, Carina Reinholdt MD PhD.Centre for Advanced Reconstruction of Extremities (C.A.R.E.), Sahlgrenska University Hospital, and Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, SwedenBackground and aims We evaluated if spasticity-reducing surgery in the upper extremity could improve motor function, fulfill patientu2019s specific goals and influence performance of daily activities in patients with muscle over-activity. Methods Thirty consecutive patients with spasticity due to stroke and other CNS injuries were included. Before surgery the patientsu2019 clinical problems related to spasticity were defined and motor function and activity assessed. Each patientu2019s potential to comply with the post-surgical rehabilitation procedure was estimated and the intensity level chosen (low, moderate or high). Surgery mainly comprised lengthening of tendons and release of muscles. Physiotherapy, occupational therapy, wrapping and application of orthoses started the first post-operative day. Patients were taught a home-training program. One week of intensive in-hospital rehabilitation followed 2-3 weeks after surgery and a new home-training program was designed. General hand function (usefulness) and pain were evaluated using the VAS scale (0-10), spasticity using the Modified Ashworth Scale (0-5) and activity by Canadian Occupational Performance Measure (performance and satisfaction mean values). Wilcoxon signed rank test was used.Results At one year follow-up general hand function increased (2.1 vs. 4.2; p< 0.001), pain decreased (3.0 vs. 1.7; p< 0.05), and spasticity decreased (3.5 vs. 2.1; p<0.001). Both activity measures: performance and satisfaction improved (2.0 vs. 5.5; p<0.01 and 1.9 vs. 5.5; p<0.01). ConclusionHand surgery combined with comprehensive rehabilitation is a therapeutic option to reduce muscle over-activity, improve hand function, reduce pain, and promote patient ability for arm-hand activities and satisfaction in daily life in patients with disabling spasticity.

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