Prevalence, impact and treatment of spasticity in nursing home patients with central nervous system disorders: a cross-sectional study

Abstract

Purpose To assess prevalence, impact and treatment of spasticity in nursing home patients with central nervous system (CNS) disorders. Methods The Modified Ashworth Scale was used as the main indicator of spasticity to assess muscle tone of the extremities. Further information was obtained on burden of care, level of independence, sleeping pattern, complaints, restrictions in functions/activities/participation and indication for treatment. Clinical assessments included coordination/sensibility parameters and various tests to assess motor performance. Results Fifty-six out of 77 participants (73%) with CNS disorders had spasticity, of whom 38 subjects also showed pathologically enhanced reflexes and 45 subjects had contractures in various joints. A high burden of care was observed in 71% and cramps/pain, cosmetic problems or other complaints due to spasticity were seen in 46, 20 and 26%, respectively. The vast majority of subjects were dependent for daily living activities and ambulation. Extra treatment of spasticity was indicated for 36% of the patients. Conclusion A high prevalence of spasticity was observed in nursing home residents with CNS disorders associated with substantial impact in terms of caregiving, complaints and compromised clinical outcome measures. To further optimize the treatment of spasticity in this vulnerable population, regional treatment plans should be developed.

Implications for Rehabilitation

• The prevalence of spasticity in nursing home residents with central nervous system disorders is high (73%).

• The impact of spasticity is substantial in terms of increased dependency in activities of daily living, increased burden of care, sleeping problems and many complaints.

• Thirty-six percent of patients could be helped by extra specialized treatment, so the challenge for the multidisciplinary rehabilitation team is huge.

• Regional treatment plans should be developed to further optimize the treatment of spasticity in the vulnerable ageing population of nursing home residents.

Keywords:

• ADL and ambulation
• burden of care
• contractures
• diagnosis
• level of independence
• motor performance

Acknowledgments

The authors wish to thank Juan Martina as organizational leader of the project for his stimulating support. We acknowledge the managers, nurses and therapists of the participating nursing homes.

Disclosure statement

None of the authors have any financial interest in the study data and there are no conflicts of interests. The research was financially supported by Ipsen Pharmaceuticals and Rehabilitation Medical Center Groot Klimmendaal Arnhem, the Netherlands. Editorial assistance in the preparation of this manuscript was provided by Dr Patricia de Groot (CtrlP).