Physiotherapy led treatment of of established finger joint contracture due to paratonia in a patient with dementia, single case study

Purpose

The evidence around treatment of this condition is weak and generally inconclusive.
The fact that the community clinic is physiotherapy led is one point to discuss.
Also the role of non-medical prescribing played a part in developing this approach.
Consultant physiotherapy role also allowed freedom to act to utilise high level clinical judgement weighing up risk and benefit where evidence is weak and medicines have to be used safely off-label.
Patients received botulinum toxin injections, analgesia, stretches with carer education via Community Physiotherapy team  and splinting via Occupational Therapy teams.
The team started treating patients based on clinically reasoned approach using what evidence existed in the patients best interests. There have been good outcomes and no adverse events. The patients often derive great benefit. Carer burden can be reduced but this was not formally evaluated. Presenting these case studies may publicise the potential for treatment as there is a general feeling that contractures are not amenable to non-surgical approaches which may not be indicated in this frail population. Part of the concern around this area is that the potential unmet need nay be great given that an estimated 6007 patients with dementia live in the hospital catchment area. There are the beginnings of discussions and research around the role of early identification / prevention being the way forwards.

Approach

Single case study of a routine case we see in our clinic. Photographic sequence of progress with treatment.

Outcomes

Results: Patient showed improvement in spite of neuro-degenerative condition, 18 month duration of abnormal hand posture. Reduced carer burden, occupational therapists were able to provide a hand splint. Patient sustained benefit when treatment ceased. 

Conclusion(s): This approach needs further investigation.

Cost and savings

The patients are seen in the clinic alongside other patients. Costs of treatment are likely to be similar to other community dwelling patients with complex physical presentations.

Implications

The impact is limited as a single case study but illustrates the team approach to addressing complex clinical problems with good patient benefit. 

Top three learning points

TBC 

Funding acknowledgements

The work was not funded but time to undertake study was part of NHS role.