Background & Aims

Stroke is a one of the leading causes of death and disability worldwide. Post stroke spasticity is common complication which can cause pain, difficulty in ambulation or transfer and may increase the risk of other complications, such as contractures and skin ulcers. Management of post stroke pain and spasticity is one of the important aspects in post stroke rehabilitation with the goal of improving quality of life in stroke survivors.

Methods

We present a case of 65 years old, male patient with underlying hypertension, diabetes mellitus, chronic kidney disease and history of recurrent stroke in 1997, 2011, 2022 and right temporo-parietal-occipital subdural haemorrhage in 2022. Patient was independent with minimal impairment until the recent stroke in 2022. He developed left dense hemiparesis with severe spasticity that resulted in excessive flexion posturing over left upper and lower limbs compounded with chronic pain over the hemiparetic side. His caregiver experienced increasing difficulty in hygiene care, positioning, and transfer of patient. He could not even sit in a wheelchair comfortably.

Results

He was admitted for inpatient rehabilitation care at one year post stroke with the aim to manage pain, spasticity, pain and subsequent reduction of caregiver burden. We adopted a multidisciplinary approach involving the rehabilitation medicine, physiotherapy, occupational therapy with the pain management team. Gradually optimisation of medications including analgesics and muscle relaxants with daily acupuncture therapy to patient performed by the pain medicine specialist. We were mindful to keep him alert to participate in therapy as most of the drugs cause sedation. Gentle stretching exercises and tilt table were provided during physiotherapy sessions. Basic personal activities of daily living retraining, basic communication and hand activities training was done by occupational therapist. Improvement was visible after 2 weeks with achievement of our goal of improving his posture, sitting balance, pain relief and eased carer burden within a month.

Conclusions

This is an exciting experience of combining medication and acupuncture for spasticity and chronic pain management. Particularly in the elderly population, high doses of sedative medication can affect their participation in activities of daily living. Combining therapies to include non-pharmacological methods is a safe and effective way to approach severe spasticity management in elderly.

References

Cai Y, Zhang CS, Liu S, Wen Z, Zhang AL, Guo X, Lu C, Xue CC. Electroacupuncture for Poststroke Spasticity: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2017 Dec;98(12):2578-2589.e4. doi: 10.1016/j.apmr.2017.03.023. Epub 2017 Apr 25. PMID: 28455191.

Chun H, Shin WC, Kim JM, Kim H, Cho JH, Song MY, Chung WS. Visual bibliometric analysis of electroacupuncture research in stroke treatment: a 20-year overview. Front Neurosci. 2023 Oct 10;17:1265854. doi: 10.3389/fnins.2023.1265854. PMID: 37901432; PMCID: PMC10600454

Zhang J, Zhu L, Tang Q. Electroacupuncture with rehabilitation training for limb spasticity reduction in post-stroke patients: A systematic review and meta-analysis. Top Stroke Rehabil. 2021 Jul;28(5):340-361. doi: 10.1080/10749357.2020.1812938. Epub 2020 Aug 26. PMID: 32845210.

Presenting Author

Devanandhini Krisnan

Poster Authors

Devanandhini Krisnan

MBBS

Manipal University

Lead Author

Shivani Rajasegaran

MBBS

Hospital Raja Permaisuri Bainun , Ipoh

Lead Author

Jia Hui Leong

MBBS

Hospital Raja Permaisuri Bainun, Ipoh

Lead Author

Topics

  • Treatment/Management: Complementary and Alternative therapies