Category: International; Brain Injury; Cross-Cutting
Objective : To examine the changes in the spasticity severity, balance and gait impairments over the course of pregnancy in an adult with cerebral palsy.
Design : Case study
Setting : Outpatient clinic
Participants (or Animals, Specimens, Cadavers) : 1 adult female with cerebral palsy and lower limb spasticity (age: 40).
Interventions : NA
Main Outcome Measure(s) : We assessed spasticity using modified Ashworth Scale (MAS), balance using Activities-specific Balance Confidence Scale, spatiotemporal gait parameters using Gaitrite device, function using Lower Extremity Functional Scale (LEFS), Quality of Life affected by lower extremity function using NeuroQOL-LE, and self-perceptions using a monthly diary at the following time points: 10-weeks, 15-weeks, 18-weeks, 26-weeks, 32-weeks, 37-weeks of pregnancy, and 4-months after delivery.
Results : The MAS did not change significantly over the course of the pregnancy or after delivery. ABC scores decreased gradually from 68 at 10-weeks to 53 at 37-weeks of pregnancy. LEFS scores decreased gradually from 43 at 10-weeks to 21 at 37-weeks of pregnancy. NeuroQOL-LE scores decreased gradually from 29 at 10-weeks to 21 at 37-weeks of pregnancy. Gait speed dropped at two time points (week 15 and 37 of pregnancy) and at 4-months post-delivery returned to above the speed at time point 1 (10-weeks). Other gait parameters did not change significantly over the course of the pregnancy. Self-reports in the diary indicate three main themes of an increase in fatigue, a decrease in balance and stability, as well as an increased assistive device use.
Conclusions : Spasticity measured using MAS and gait did not alter significantly. There were important changes in lower extremity function, balance and quality of life as assessed using questionnaires and self-perception.
Chetan Phadke
– Scientist, West Park Healthcare Centre, Toronto, OntarioShannon Reid
– Physiotherapist, Spasticity Clinic, West Park Healthcare Centre, Toronto, OntarioAyako Sasaki
– Occupational Therapist, West Park Healthcare Centre, Toronto, OntarioAlexandra Oatley
– Research, University Health Network, Toronto, Ontario, Canada, Toronto, OntarioFarooq Ismail
– Physiatrist, West Park Healthcare Centre, Toronto, OntarioChris Boulias
– Physiatrist, West Park Healthcare Centre, Toronto, Ontario