1. Factors that Influence Spasticity in Individuals with Stroke and Multiple Sclerosis Janice Cheung 1, Amanda Rancourt 1, Stephanie Di Poce 1, Amy Levine 1, Jessica Hoang 1, Farooq Ismail 2, Chris Boulias 2, Dina Brooks 1, Chetan P. Phadke 2 1-University of Toronto, Masters of Science, Physiotherapy Program 2-Spasticity Research Program, West Park Healthcare Centre, Ontario, Canada Stroke and Multiple Sclerosis (MS) are leading causes of neurological disability in Canada. Spasticity is a common symptom in stroke and MS. It has been suggested that spasticity severity can be influenced by personal and environmental factors 1. INTRODUCTION 1.Factors that Influence Perceived Spasticity Severity Stroke Majority reported no change to spasticity with the following: sitting (72%), having a full bladder (69%), need for bowel movement (69%) Factors that increased spasticity: muscle fatigue (59%), stress or anxiety (59%), outdoor cold (69%) MS No change with need for bowel movement (77%) Increased spasticity with: lying supine (56%), muscle fatigue (78%), outdoor (67%) and indoor (78%) cold, outdoor heat (67%), stress or anxiety (89%) 2. Nature and Extent of Spasticity 3.Relationship between Time since Diagnosis and Perceived Impact on ADLs No statistical significant correlation in Stroke (r= - 0.07, p=0.37) or MS (r= 0.15, p=0.36) RESULTS Cold, muscle fatigue, and stress may increase the sensitivity of the muscle spindle receptors Heat increases spasticity in MS due to Uhthoff’s Phenomenon 2 Some factors (bowel/bladder, tight clothing, posture) found to increase spasticity in spinal cord injuries had no effect in stroke and MS Physiological mechanisms of how these triggers influence perceived spasticity is not fully understood The non-significant finding between time since diagnosis and function can be due to the effect of hand dominance and limited sample size. DISCUSSION Factors that Increase Perceived Spasticity 1. To identify factors that are perceived to increase or decrease spasticity 2.To describe the nature, extent, and impact of spasticity 3.To determine if there is an association between time since diagnosis and impact of spasticity on ADLs OBJECTIVES Participants 29 individuals with stroke and 9 with MS were recruited Study Design Cross-sectional telephone survey Questionnaire mailed out prior to telephone contact Questionnaire Items on location and pattern of spasticity Intensity of spasticity using 11-point numeric rating scale Patient-Reported Impact of Spasticity Measure (PRISM), daily activities subscale Influence of 19 factors on spasticity intensity using 7-point scale (1-3=better, 4=no change, 5-7=worse) METHODS StrokeMS Location79% have spasticity in both the arm and leg 44% have spasticity in both arm and leg Severityhigh spasticity in both arm (7/10) Moderate leg spasticity (5/10) High spasticity in the leg (7/10) Moderate arm spasticity (5/10) Change over past week 61% reported fluctuations in arm spasticity severity 50% had no change in leg spasticity 60% reported change in arm spasticity severity 50% with leg spasticity reported no change Impact on ADLs Median PRISM score: 7.0/24 Function affected Mean PRISM score: 9.7/24 Function affected Stroke MS Education on spasticity management should be tailored to the individual and their specific neurological condition Future research should examine how these triggers influence objective measures of spasticity Influence of factors on perceived spasticity should be studied in other neurological conditions FUTURE IMPLICATIONS Factors Posture and position changes Bowel and Bladder issues Time of day Mental stress Pregnancy Temperature Triggers of Spasticity Menstrual cycle Tight-fitting apparel Fatigue REFERENCES ACKNOWLEDGMENTS We would like to thank all our participants for their time and the West Park Foundation for their support. 1.Phadke 2013 2.Uhthoff phenomenon