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, Ontario
Shannon Reid– Physiotherapist, Spasticity Clinic, West Park Healthcare Centre, Toronto, Ontario
Ayako Sasaki– Occupational Therapist, West Park Healthcare Centre, Toronto, Ontario
Alexandra Oatley– Research, University Health Network, Toronto, Ontario, Canada, Toronto, Ontario
Farooq Ismail– Physiatrist, West Park Healthcare Centre, Toronto, Ontario
Chris Boulias– Physiatrist, West Park Healthcare Centre, Toronto, Ontario