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Spasticity clinic leads nation with orthopedic surgeon, gait lab

March 3, 2015

Teamwork eases suffering, makes dramatic changes in quality of patients’ lives

EDMONTON — Albertans with tight or stiff muscles can now regain ease of movement, more independence and improved quality of life at a new specialized clinic that streamlines their care.

Located at Glenrose Rehabilitation Hospital, the Adult Interdisciplinary Orthopedic Spasticity Clinic is the first of its kind in Canada with both an orthopedic surgeon on board as well as diagnostic input from a state-of-the-art gait lab, the Syncrude Centre for Motion and Balance.

The clinic represents the latest evolution of a team-approach spasticity program that began in 2006 with 108 patients and 565 visits. Since then, it has doubled its annual capacity to 223 new patients with 1,437 patient visits overall in 2014.

“Managing spasticity cannot be done by one individual. We need a team to deal with this,” says Dr. Lalith Satkunam, Professor and Medical Lead for the spasticity program. “That’s where the Glenrose has been a national leader. Now we’re taking it to a new level, with orthopedic surgeons joining the team to work with patients to decide on the best surgical option.”

“Creating abilities for life; that’s our mission,” adds Gail Aguillon, Interim Director of Adult Rehabilitation for the hospital. “This is another example of the Glenrose taking leadership in rehabilitation medicine. That’s what we do best.”

Spasticity is stiff or rigid muscles — sometimes described as unusual tightness or increased muscle tone — which can put people into very abnormal postures and hamper their day-to-day ability to care for themselves. It’s a condition that impairs quality of life as it distorts walking, movement or speech. Causes are diverse and include brain damage, cerebral palsy, head injury, multiple sclerosis, spinal cord injury, stroke and more.

“This clinic is groundbreaking,” says orthopedic surgeon Dr. Angela Scharfenberger, who joined the team in November. “This is a new approach to deal with adult patients with spasticity and draws on the principles of cerebral palsy surgery seen in pediatric orthopedics surgery.”

She now works with health professionals drawn from physiatry, neurosurgery, nursing, physical therapy, occupational therapy, orthotics, kinesiology, pharmacy and more.

Having an orthopedic surgeon on board is a huge benefit for patients, who can now be treated in a more comprehensive, convenient, one-stop way. Should they require surgery to lengthen muscles or loosen tendons, for example, their care pathway is now quicker and more direct.

A multidisciplinary approach with the physiatrists (rehab medicine specialists) and rehab clinicians at the Glenrose is the ideal, adds Dr. Scharfenberger. “EMG (nerve-conduction) studies, gait analysis, Botox injections and bracing are all required in conjunction with surgical intervention to provide the best possible outcome for our spasticity patients,” she says.

Donna Durnford, whose multiple sclerosis led to a severely twisted left foot, says the clinic has changed her life.

“The spasticity in my calf was so rigid that I couldn’t move my ankle,” says the 46-year-old Grande Prairie woman. “My toes were facing down and my foot was twisted. Walking was horrendously painful. So they surgically added around three inches to my Achilles tendon to bring my foot up to a normal position. I still have to wear a brace but I can walk a lot longer now. I’m not in pain.”

The mother of two and her husband Bill celebrated their silver wedding anniversary last year with a dream holiday in Spain, Portugal and Morocco, and last month enjoyed snorkelling in Mexico.
“I never would have been able to do these trips if I hadn’t had the surgery,” she says.

Dr. Scharfenberger says Durnford’s outcome is not unique.

“The final functional gains for our patients are life-altering, with increased walking abilities, decreased bracing requirements, and overall decrease in patient pain and increase in function,” she says. “The surgeries and rehabilitation provide dramatic changes in these patients’ lives.”

Other treatments for spasticity can include muscle-calming medications as well as implanting a pump inside the body to deliver drugs directly to the spine.

“We have a number of people from other centres in the country and around the world coming here to observe our approach,” says Dr. Satkunam. “We also train physicians from other provinces.”

Wendy Dugas, President and CEO of the Glenrose Rehabilitation Hospital Foundation, says the clinic is a great example of how the Glenrose delivers outstanding patient care through innovation.

“Dr. Satkunam is constantly seeking new treatments to support patients,” Dugas says. “Our foundation raised funds to establish the Syncrude Centre for Motion and Balance. Seeing this recent advancement reinforces how donor investments can have an ever-lasting impact.”

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