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

 Stroke: largest cause of disability in the UK 1  Stroke care costs: 8.9 billion pounds in the UK 2  Globally: stroke is one of the most devastating of all neurological diseases  Stroke often leads to death, physical impairment and disability 3

 Upper limb (UL) rehabilitation: remains a huge problem in people with dense stroke 4  trunk function and UL impairment: correlated with overall functional independence 5  Arm recovery: correlated to daily life autonomy in stroke patients 6

 Loss of extensor strength in the affected UL is correlated to poor UL activity and function 7  A third of stroke patients go on to develop spasticity of the affected UL 8  IMPORTANT to find rehabilitation interventions that improve UL recovery and THUS reduce spasticity of the UL in dense strokes.

 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

 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.

Inclusion Criteria Exclusion Criteria 1. Complete loss of voluntary 1. Partial loss of movement movement, pre-treatment as signified as denoted by scores of 1/5 by 0/5 on Oxford Scale or above on the Oxford Scale to 85 years of age inclusive 2. Under 65 or above 85 years 3. First dense stroke 3. Posterior circulation strokes 4. Independently mobile before the stroke 4. Type II Miller-Fisher disease 5. Parietal centred strokes 5. Temporo-parietal strokes

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

 Deceased while on Liverpool Care Pathway (LCP) (n=3)  Deceased after discharge (n=16)  Did not consent (n=10)

 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)

Variable OKCSIB Protocol Value (SD) Conventional Value (SD) p UL STREAM 18.8 (1.5) 9.8 (6.9) 0.04 MAS 0 (100%) 0 (25%) (75%)

 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.