Use of the OKCSIB protocol for upper limb recovery in dense acute strokes

ByBen Chitambira

RSW, WHH, EKHUFT

Background

Stroke: largest cause of disability in the UK 1

Stroke care costs: 8.9 billion pounds in the UK2

Globally: stroke is one of the most devastating of all neurological diseases

Stroke often leads to death, physical impairment and disability3

The challenge of UL rehabilitation

Upper limb (UL) rehabilitation: remains a huge problem in people with dense stroke4

trunk function and UL impairment: correlated with overall functional independence5

Arm recovery: correlated to daily life autonomy in stroke patients6

The extensor system and the UL

Loss of extensor strength in the affected UL is correlated to poor UL activity and function7

A third of stroke patients go on to develop spasticity of the affected UL8

IMPORTANT to find rehabilitation interventions that improve UL recovery and THUS reduce spasticity of the UL in dense strokes.

Aim

To explore if use of the optokinetic chart based OKCSIB protocol had led to better and long lasting UL recovery when compared to conventional neurophysiotherapy using a retrospective case control series

Methodology

Design: retrospective case control series in the community

Ethics: favourable opinion from Kent Research Ethics Committee

NHS permission to proceed from EKHUFT R&D Database of 643 people with stroke admitted

January 2008 to first September 2010 used.

Sampling Procedure

Inclusion Criteria Exclusion Criteria

1. Complete loss of voluntary 1. Partial loss of movement

movement, pre-treatment as signified as denoted by scores of 1/5

by 0/5 on Oxford Scale or above on the Oxford Scale

2. 65 to 85 years of age inclusive 2. Under 65 or above 85 years

3. First dense stroke 3. Posterior circulation strokes

 

4. Independently mobile before the stroke 4. Type II Miller-Fisher disease

 

5. Parietal centred strokes 5. Temporo-parietal strokes

Excluded

No dense UL weakness (n=432)

Not aged 65 to 85 inclusive (n=106)

Not parietal centred stroke (n=68)

Excluded

Deceased while on Liverpool Care Pathway (LCP) (n=3)

Deceased after discharge (n=16)

Did not consent (n=10)

Results

8 participants consented to be followed up 3 years after their stroke.

Equal number of participants who had been treated by OKCSIB protocol and conventional neuro-physiotherapy (n=4 respectively)

Voluntary Movement Results

OKCSIB Conven OKCSIB Conven OKCSIB Conven OKCSIB Conven0

5

10

15

20

25

17

5

20

7

18

7

20 20

UL STREAM

Spasticity Results

OKCSIB Conven OKCSIB Conven OKCSIB Conven OKCSIB Conven0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

0

4

0

4

0

4

0 0

Hand

MAS

Data Analysis Results Variable OKCSIB Protocol Value (SD) Conventional Value (SD) p 

UL STREAM 18.8 (1.5) 9.8 (6.9) 0.04

MAS 0 (100%) 0 (25%) 0.04 4 (75%)

Discussion

OKCSIB protocol: statistically significant improvement in UL recovery

Striking finding: absence of affected hand spasticity in the OKCSIB group

Key is in the rehabilitation of the anti-gravity extensor system which supports voluntary movement.