Practical Guidance for Outpatient Spasticity Management During the Coronavirus (COVID-19) Pandemic: Canadian Spasticity COVID-19 Task Force

• Published in: Canadian Journal of Neurological Sciences 2020-09, Vol.47 (5), p.589-593
• Main Authors: Reebye, Rajiv, Finlayson, Heather, May, Curtis, Satkunam, Lalith, Wein, Theodore, Miller, Thomas, Boulias, Chris, O’Connell, Colleen, Bohorquez, Anibal, Dukelow, Sean, Ethans, Karen, Ismail, Farooq, Khalil, Waill, Khan, Omar, Lagnau, Philippe, McNeil, Stephen, Mills, Patricia, Sirois, Geneviève, Winston, Paul
• Format: Article
• Language: English
• Subjects: Advisory Committees - standards; Asymptomatic; Betacoronavirus; Canada - epidemiology; Commentary; Coronavirus Infections - epidemiology; Coronavirus Infections - therapy; Coronaviruses; COVID-19; Disease transmission; Fever; Humans; Masks; Medical supplies; Muscle Spasticity - epidemiology; Muscle Spasticity - therapy; Outpatient care facilities; Pandemics; Pandemics - prevention & control; Patients; Personal protective equipment; Pneumonia, Viral - epidemiology; Pneumonia, Viral - therapy; Practice Guidelines as Topic - standards; Range of motion; SARS-CoV-2; Spasticity; Task forces; Telemedicine
• ISSN: 0317-1671; 2057-0155
• DOI: 10.1017/cjn.2020.104

Background Spasticity is a common sequela of upper motor neuron conditions that can reduce quality of life, impair function, and heighten economic burden.Reference Esquenazi1 Identification and treatment of problematic spasticity is key in order to decrease impairments including contracture formation, pain, skin breakdown, and functional decline and to limit disability.Reference Wissel, Verrier and Simpson2 The COVID-19 pandemic has affected health-care systems worldwide including physical medicine and rehabilitation (PMR) and neurology practices in Canada.Reference Carda, Invernizzi and Bavikatte3-Reference Escalon and Herrera5 Inpatient hospital care for the management of patients with COVID-19 has been prioritized, while elective surgeries and outpatient clinics have been limited or canceled as part of resource allocation management and mitigation of risks during the pandemic. Telemedicine is obviously limited due to the inability to perform a full physical examination to adequately assess spasticity, tone, and contracture, and in certain clinical scenarios, in-person assessment becomes essential to ensure appropriate treatment. Screen patients by phone prior to in-person assessments to ensure no COVID-19 symptoms, including fever, cough, shortness of breath, chills, muscle pain, new loss of taste or smell, vomiting or diarrhea, and/or sore throat or close contacts who are ill prior to attending.11 Advise patients to use the local health authority self-assessment tool. Given the current outbreaks in long-term care (LTC) facilities, we recommend not to transfer patients from LTC or other assisted living and group home settings to outpatient clinics during the pandemic unless urgent or semi-urgent.