For individuals with acquired brain injury and severe upper limb spasticity, personal care is often difficult, time-consuming and painful. Previous studies on outcomes after surgery for upper limb spasticity have focused on functional gain, pain, hygiene and appearance. We operated on 38 non-communicative patients (45 limbs, 535 procedures) with severe spasticity and a non-functional upper limb(s). The surgical goals were to provide opening of the fingers and thumb, wrist stability and, if required, to release muscles around the elbow and shoulder. We used the Carer Burden Score as a relevant outcome measure. Preoperatively and 3 months postoperatively, the carer rated the degree of difficulty in cleaning the palm, cutting the fingernails, cleaning the axilla and dressing the upper body on a 5-point Likert scale. Surgery significantly improved the ease of care, which has implications not only for the patient but also for carers and associated health costs.
BakheitAM. The pharmacological management of post-stroke muscle spasticity. Drugs Aging. 2012, 29: 941–7.
2.
Bhakta BB, Cozens JA, Chamberlain MA, Bamford JM. Impact of botulinum toxin type A on disability and carer burden due to arm spasticity after stroke: a randomised double blind placebo controlled trial. J Neurol Neurosurg Psychiatry. 2000, 69: 217–21. Erratum in: J Neurol Neurosurg Psychiatry. 2001, 70: 821.
3.
BotteMJKeenanMAKorchekJIWatersRL. Modified technique for the superficialis-to-profundus transfer in the treatment of adults with spastic clenched fist deformity. J Hand Surg Am. 1987, 12: 639–40.
4.
DennoMSGillardPJGrahamGD, et al.Anxiety and depression associated with caregiver burden in caregivers of stroke survivors with spasticity. Arch Phys Med Rehabil. 2013, 94: 1731–6.
5.
DoanQVBrashearAGillardPJ, et al.Relationship between disability and health-related quality of life and caregiver burden in patients with upper limb poststroke spasticity. PM R. 2012, 4: 4–10.
6.
DoanQVGillardPBrashearA, et al.Cost-effectiveness of onabotulinumtoxinA for the treatment of wrist and hand disability due to upper-limb post-stroke spasticity in Scotland. Eur J Neurol. 2013, 20: 773–80.
7.
EsquenaziA. Improvements in healthcare and cost benefits associated with botulinum toxin treatment of spasticity and muscle overactivity. Eur J Neurol. 2006, 13(Suppl 4): 27–34.
8.
EsquenaziA. The human and economic burden of poststroke spasticity and muscle overactivity. JCOM. 2011, 18: 607–14.
9.
FaccaSLouisPIsnerME, et al.Braun’s flexor tendons transfer in disabled hands by central nervous system lesions. Orthop Traumatol Surg Res. 2010, 96: 656–61.
10.
FeiginVLForouzanfarMHKrishnamurthiR, et al.Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014, 383: 245–54. Erratum in Lancet. 2014, 383: 218.
11.
FeiginVLLawesCMBennettDABarker-ColloSLParagV. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009, 8: 355–69.
12.
Fortune N, Wen X. The definition, incidence and prevalence of acquired brain injury in Australia. Canberra, Australian Institute of Health and Welfare, 1999, Vol. AIHW Cat. no. DIS 15: 1–123.
13.
HeijnenICFrankenRJBevaartBJMeijerJW. Long-term outcome of superficialis-to-profundus tendon transfer in patients with clenched fist due to spastic hemiplegia. Disabil Rehabil. 2008, 30: 675–8.
14.
HouseJHGwathmeyFWFidlerMO. A dynamic approach to the thumb-in palm deformity in cerebral palsy. J Bone Joint Surg Am. 1981, 63: 216–25.
15.
JagnoorJCameronID. Traumatic brain injury–support for injured people and their carers. Aust Fam Physician. 2014, 43: 758–63.
16.
KeenanMAKorchekJIBotteMJSmithCWGarlandDE. Results of transfer of the flexor digitorum superficialis tendons to the flexor digitorum profundus tendons in adults with acquired spasticity of the hand. J Bone Joint Surg Am. 1987, 69: 1127–32.
17.
LundströmESmitsABorgJTeréntA. Four-fold increase in direct costs of stroke survivors with spasticity compared with stroke survivors without spasticity: the first year after the event. Stroke. 2010, 41: 319–24.
18.
MozaffarianDBenjaminEJGoAS, et al.Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2016, 133: e38–360. Erratum in: Circulation. 2016, 133(15): e599.
19.
PappasNBaldwinKKeenanMA. Efficacy of median nerve recurrent branch neurectomy as an adjunct to ulnar motor nerve neurectomy and wrist arthrodesis at the time of superficialis to profundus transfer in prevention of intrinsic spastic thumb-in-palm deformity. J Hand Surg Am. 2010, 35: 1310–6.
20.
PappasNBaldwinKKeenanMA. Treatment of the non-functional contracted hand. University of Pennsylvania Orthopaedic Journal. 2011, 21: 90–2.
21.
PerautETaïebLJourdanC, et al.Results and complications of superficialis-to-profundus tendon transfer in brain-damaged patients, a series of 26 patients. Orthop Traumatol Surg Res. 2018, 104: 121–6.
22.
PomeranceJFKeenanMA. Correction of severe spastic flexion contractures in the nonfunctional hand. J Hand Surg Am. 1996, 21: 828–33.
23.
ShackleyPShawLPriceC, et al.Cost-effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A: results from the botulinum toxin for the upper limb after stroke (BoTULS) trial. Toxins (Basel). 2012, 4: 1415–26.
24.
SunnerhagenKSOpheimAAlt MurphyM. Onset, time course and prediction of spasticity after stroke or traumatic brain injury. Ann Phys Rehabil Med.2018. May 16. pii: S1877-0657(18)30059-9.
25.
TangJBGiddinsG. Why and how to report surgeons’ levels of expertise. J Hand Surg Eur. 2016, 41: 365–6.
26.
TangWKLauCGMokVUngvariGSWongKS. Burden of Chinese stroke family caregivers: the Hong Kong experience. Arch Phys Med Rehabil. 2011, 92: 1462–7.
27.
Thevenin-LemoineCDenormandiePSchnitzlerALautridouCAllieuYGenêtF. Flexor origin slide for contracture of spastic finger flexor muscles: a retrospective study. J Bone Joint Surg Am. 2013, 95: 446–53.
28.
WedekindCLippert-GrünerM. Long-term outcome in severe traumatic brain injury is significantly influenced by brainstem involvement. Brain Inj. 2005, 19: 681–4.
29.
ZorowitzRDGillardPJBraininM. Poststroke spasticity: sequelae and burden on stroke survivors and caregivers. Neurology. 2013, 80: S45–52.
