College Knowledge Exchange - Demonstrating the need for long term neurological surveillance in chronic stroke

Overview

The College Knowledge Exchange is a series of presentations delivered by Fellows of the Australian College of Physiotherapists (the College) exclusively for members of the College. Including a presentation (approx. 20min) followed by the opportunity for Q&A and peer-to-peer interaction, the College Knowledge Exchange is a great opportunity to connect with the College network and learn from the experience of your esteemed College peers.

Case study abstract:

Background - Cervical myelopathy can be elusive to diagnose, particularly when presenting in those with existing neurological pathology. It is the responsibility of the primary healthcare professionals to recognize symptoms of cervical myelopathy, differentially diagnose and initiate treatment.
Objective - The aim of this complex case was to describe the differential diagnosis of cervical myelopathy in a patient attending physiotherapy for chronic stroke management.
Method - Dynamic changes in muscle tone and sensation, and reduced upper limb function were red flags to ongoing chronic stroke management. A new diagnosis was considered. Key additional diagnostic tests included impartment measures (strength, sensation spasticity, co-ordination and proprioception); activity measures included 10 metre walk test (10MWT), 6 minute walk test (6MWT) and Nine-Hole peg test (9-HPT). Alternative disease states (e.g. Amyotrophic Lateral Sclerosis, stroke, tumor carpel tunnel, botulinum toxin side effects, shoulder pathology) were excluded in the differential diagnosis via investigations (e.g. Magnetic resonance imaging (MRI) brain and shoulder, sensory testing, carpal compression test, functional anatomy).
Results - New symptoms of cervical myelopathy were suspected clinically that did not match the temporal nature of stroke and confirmed with MRI. The patient was referred to neurosurgery and a posterior cervical laminectomy and fusion C3-C7 performed. Six weeks following surgery, gains were observed in mobility performance (10MWT and 6MWT) and upper limb function (9-HPT and grip strength), along with reduced reliance on mobility aids.
Conclusion - This study demonstrates the need for longitudinal rigorous neurologic surveillance in stroke populations to ensure rapid treatment of new diagnosis when existing with chronic neurological impairments.

Presenter

Elizabeth Moore has worked in neurological and acquired brain injury rehabilitation for 17 years. She is a Specialist Neurological Physiotherapist and Fellow of the Australian College of Physiotherapists (as awarded by the Australian College of Physiotherapists in 2022). Elizabeth is a clinical leader in the management of adult focal spasticity and was integral in founding one of the first multi-disciplinary spasticity clinics in Australia in 2008. She has been the senior clinician in this clinic since its inauguration. She has four peer reviewed publications and one book publication. Elizabeth was a lead author of the standardised protocol for the Modified Tardieu Scale, which is used by clinicians and students across Australia.