FOCAL SPASTICITY MANAGEMENT USING COLLABORATIVE MULTIDISCIPLINARY REHABILITATION IN A CASE OF UNIQUE DUAL DIAGNOSIS WITH STROKE
Bibliographic record
Abstract
Barathi Sreenivasan1, MD, FRCPC, CSCN (EMG) Diplomate, Julian Spears2 , MD, SM, FRCSC, FACS, Chaya Plonka1, PT, Anne Hackland1, OT, Darinka Jokanovic1, RN, Rauni Somogyi1, SW, RSW. 1. University of Toronto, Sunnybrook Hospital, Toronto, Canada 2. University of Toronto, St. Michaelu2019s Hospital, Toronto, CanadaBackground: 53 year old male presented with the unique combination of left posterior frontal CVA and right frontal meningioma resection attended outpatient rehabilitation. Patient developed increased tone in hip adductors, quadriceps, and gastrocsoleus, resulting in difficulty with passive stretch and Activities of Daily Living (ADLu2019s) including ambulation, transfers, dressing, bathing, and sleep. Examination showed focal spasticity with Modified Ashworth (MAS) in hip adductors and gastrocsoleus of grade 4 bilaterally and quadriceps grade 3 on the right and 2 on the left and bilateral ankle clonus. Passive inter-adductor distance was 575 mm. Wong-Baker faces pain score was 6/10. Treatment: According to Canadian Stroke Best Practices Recommendations, patient underwent multidisciplinary rehabilitation. This included Occupational Therapy addressing ADLu2019s, transfers, stretching, and upper extremity positioning. Physiotherapy addressed gait, balance, lower extremity positioning and stretching. Nursing assisted physician with positioning during spasticity management focal injections and counselled patient. Physician treated patient initially with oral antispasticity agents, followed by focal botulinum toxin injections to bilateral hip adductors and gastrocsoleus. Quadriceps were not injected due to functional contribution of quadriceps tone to upright stance and transfers. Results: Patient reported improvement in passive stretch and ADLu2019s including sleep, dressing, toileting, cleaning and transfers and ambulation distances. Physical examination showed improvement in MAS in hip adductors and gastrocsoleus, with elimination of ankle clonus. The Wong-Baker faces pain rating scale improved to 0/10. Passive inter-Adductor distance improved to 627 mm. Conclusion: Patients with unique double diagnoses of stroke and meningioma can benefit from collaborative multidisciplinary spasticity rehabilitation management. Keywords spasticitystrokemultidisciplinaryrehabilitationunique
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.010 | 0.007 |
| Science and technology studies | 0.000 | 0.002 |
| Scholarly communication | 0.002 | 0.007 |
| Open science | 0.003 | 0.007 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".