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

Use of the OKCSIB protocol for upper limb recovery in dense acute strokes. By Ben Chitambira RSW, WHH, EKHUFT. Background. Stroke: largest cause of disability in the UK 1 Stroke care costs: 8.9 billion pounds in the UK 2

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

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  1. Use of the OKCSIB protocol for upper limb recovery in dense acute strokes By Ben Chitambira RSW, WHH, EKHUFT

  2. 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

  3. 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

  4. 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.

  5. 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

  6. 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.

  7. Sampling Procedure

  8. Excluded • No dense UL weakness (n=432) • Not aged 65 to 85 inclusive (n=106) • Not parietal centred stroke (n=68)

  9. Excluded • Deceased while on Liverpool Care Pathway (LCP) (n=3) • Deceased after discharge (n=16) • Did not consent (n=10)

  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)

  11. Voluntary Movement Results

  12. Spasticity Results

  13. Data Analysis Results

  14. 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.

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