G484(P) Evaluation of spasticity services in a dgh

Abstract

Background Cerebral Palsy (CP) is the most common paediatric condition with spasticity. The prevalence of CP in the UK is 186/100000. NICE recommends that all children and young people (CYP) with spasticity be referred to a network of team and assessed by a physiotherapist and or occupational therapist. We should offer a therapy programme tailored to the CYP’s individual needs aimed at specific goals such as enhancing skills, function, participation and preventing complications. Botulinum toxin (BoNT) is offered for focal spasticity if it is impeding function, compromising hygiene, causing pain, impeding tolerance of other treatment and causing cosmetic concerns to CYP. A careful assessment of baseline muscle tone, range of movements and function against response to treatment is undertaken before injection, 6–12 weeks and 12–26 weeks after injections. Aim To review whether spasticity management programme is individualised, goal focussed and NICE compliant. To assess use of BoNT, monitor CYP’s response to treatment and development of complications. Methods Retrospective review of notes of all patients who received BoNT treatment within our spasticity service between 2012- ‘15. 59 patients were assessed in spasticity clinic during this period and 19 qualified and recieved BoNT treatment. Results Cerebral palsy was the aetiology in 84% and stroke in 11% in the treated group. One third had severely affected motor skills (GMFCS IV/V). Majority were injected for impeding motor function (84%). Other reasons include compromised care (40%), pain (20%), and cosmesis (8%). Upper limb was injected in 32%, lower limb in 52%, and both in 16%. Physiotherapist was involved in the assessments in all cases. Consent was obtained in all. Information leaflets were provided in 95% of patients. There were no complications. 89% of patients achieved their treatment goals. In 47% treatment goals were exceeded. Overall improvement was noted in 84%. Further interventions undertaken after BoNT treatment include selective Dorsal Rhizotomy (5%), Multilevel surgery (21%), Intrathecal Baclofen (5%), Gait analysis (26%). Conclusion Majority of BoNT treated patients had spastic CP. Improvement of motor function was the main goal for treatment. There were no complications. 89% achieved their treatment goals and 84% reported overall improvement, both in their motor function and general well-being.