Seasonal Variations in Outdoor Activities in Adults With
Spasticity
Sachindri
Wijekoon, Kim-Minh Tran-Nguyen, Farooq Ismail, Chris Boulias, Chetan P. Phadke
Sachindri Wijekoon,
Kim-Minh Tran-Nguyen, Department of Occupational Therapy, University of Toronto,
Toronto, Canada
Farooq Ismail,
Chris Boulias, Chetan P. Phadke, Spasticity
Research Program, West Park Healthcare Centre, Toronto, Canada
Farooq Ismail,
Chris Boulias, Division of
Physiatry, Department of Medicine, University of Toronto, Toronto, Canada
Chetan P. Phadke, Department of Physical Therapy,
University of Toronto, Toronto, Canada
Chetan P. Phadke, Faculty of Health, York University,
Toronto, Canada
Correspondence to: Chetan P. Phadke, Scientist,
Spasticity Research Program; West Park Healthcare Centre, 82 Buttonwood Ave,
Toronto, ON, M6M 2J5, Canada
Email: chetan.phadke@westpark.org
Telephone: +1-416-243-3600 x 2716
Fax: +1-416-243-3747
Received: May 20, 2015
Revised: June 10, 2015
Accepted: June 16, 2015
Published online: September 1, 2015
ABSTRACT
Background:
Spasticity can worsen in winter and result in additional functional impairment.
Objective:
This study examined the perceived differences in, and barriers to duration and
types of outdoor activities performed in winter and summer in adults with
spasticity.
Methods:
Thirty adults with spasticity completed a phone questionnaire, which explored
the types and durations of outdoor activities between summer and winter. Data
were analyzed quantitatively and qualitatively.
Results:
Time spent outdoors was four times greater in summer (p<0.01) with
participants reporting spending an average of 227 minutes/day, compared to 62
minutes/day in winter. Duration of life-enhancing activities in winter was
reduced. The amount of time spent outdoors in winter was negatively correlated
with upper extremity spasticity (r =-0.39, p<0.05).
Furthermore, social, structural, and service barriers reduced the duration of
outdoor activities regardless of season.
Conclusions:
Particular emphasis should be placed on management of spasticity, education,
and advocacy for individuals with spasticity to enhance outdoor activity
engagement during the winter.
© 2015 ACT. All
rights reserved.
Key words: Muscle spasticity, Cold temperature; Hot temperature;
Activities of daily living; Leisure activities; Seasonal variation
Wijekoon S,
Tran-Nguyen KM, Ismail F, Boulias C, Phadke CP. Seasonal Variations in Outdoor
Activities in Adults With Spasticity. International
Journal of Neurology Research 2015; 1(3): 163-168 Available from: URL:
http://www.ghrnet.org/index.php/ijnr/article/view/1220
Introduction
Spasticity is a clinical sign of upper motor neuron (UMN) lesion,
resulting in “intermittent or sustained involuntary muscle activation”[1].
Spasticity can vary from mild muscle stiffness to severe, painful, and
involuntary muscle spasms[2]. Spasticity affects at least 35% of
people post-stroke[3], 80% of people with multiple sclerosis (MS)[4],
65-78% of individuals with spinal cord injury (SCI)[5], and 80% of
people with cerebral palsy (CP)[6]; however, the prevalence of
spasticity among individuals with traumatic brain injury (TBI) remains
undocumented[7].
Spasticity has
been reported to worsen in extreme cold conditions in persons with SCI
resulting in difficulties with outdoor mobility[8]. Although the
exact mechanism of increased spasticity in cold temperatures remains untested,
an increase in sensitivity of muscle spindles in response to cold weather
reported in animal studies[9] may offer a possible explanation.
Another possible mechanism may be related to hyperexcitability following UMN
lesions. The generalized increase in reflex excitability may also amplify the
thermoregulatory reflex pathways[9], underlying the shivering
response that generates heat and restores body temperature[10].
Spasticity
along with other signs of UMN lesions diminishes the individual’s capacity to
engage in self-care, productivity, and leisure occupations[11].
Spasticity in upper extremity (UE) and lower extremity (LE) compromises several
outdoor activities such as ambulation, transferring, propulsion of a wheelchair[12],
gait aid manipulation, and vehicle operation. Outdoor activities are known to
be limited in winter in healthy control population[13] and UMN
lesions such as SCI impose further limitations in outdoor activities[14].
McColl et al (2002) found that weather restricts mobility for Canadians
with SCI more than American and British comparison groups, presumably because
of greater seasonal variability of temperatures in Canada. The additional
effect of cold weather can worsen the functional impact of spasticity resulting
in additional limitations in outdoor activities. It is important to study these
differences because patients with spasticity may be more susceptible to weather
related impact on outdoor activities. Studying the differences in duration and
types of outdoor activities, as well as barriers to outdoor activities, in
winter and summer conditions is particularly important in regions with
drastically different seasonal temperatures such as Canada.
We
hypothesized that (1) duration of outdoor activity will be lower in winter
compared to summer, with less variety of outdoor activities performed in
winter; (2) higher spasticity severity levels experienced in winter will result
in less time spent outdoors; and (3) the environmental and resource barriers
identified by individuals with spasticity will further limit outdoor
activities.
Methods
Study design
A mixed methods design was adopted to capture the differences in
duration and types of outdoor activities in summer and winter conditions in
adults with spasticity. A previous study[15] used objective means to
quantify seasonal variations in physical activity; however, a subjective
account would allow for a better understanding of the perceived challenges
influencing seasonal differences in outdoor activity levels. A cross-sectional
method was used due to feasibility, resource availability, and time
constraints.
The variables
under investigation were operationally defined as the types and durations
(minutes per day) of outdoor activities in summer and winter. Qualitative forms
of data (types of outdoor activities and participant descriptions of challenges
to outdoor activity participation) along with quantitative forms of data
(duration of activities and perceived spasticity severity) were used to
minimize researcher bias and understand the subjective voices of participants[16,17].
Participants
Ethical approval for the study was obtained from the hospital and
university research ethics boards. A convenience sample of 30 community-dwelling
adults with spasticity attending an outpatient spasticity clinic in Ontario, a
province in Canada with a large difference in weather between summer and
winter, was recruited. Participants were mailed study recruitment packages
outlining the purpose, nature, and procedure of the study, as well as the
questionnaire (see Appendix 1).
Participants
were included if they met the following inclusion criteria: (a) 18 years of age
or older; (b) spasticity in either/both UE and LE; (c) community dwelling
residents of Ontario; and (d) experienced both summer and winter conditions
following a diagnosis of spasticity. Participants were excluded from our study
if: they (a) had inadequate means of communication over the phone; and (b)
inability to answer simple questions (yes/no) as determined by the treating
clinician.
Data collection
– Measures
We used a 15-item questionnaire developed by the primary investigators
for the purpose of this study (see Appendix 1). Questions included items
adapted from the Neighborhood Environment Walkability Survey (NEWS)[18],
a reliable and validated 98-item self-report questionnaire measuring residents’
perceptions of neighborhood characteristics. Specifically, the “The stores,
facilities, and other things in your neighborhood” subscale from the NEWS
questionnaire was adapted to capture types and duration of participation
(minutes/day) of outdoor activities in summer and winter. Participants were
asked to select the types of outdoor activities they engage in from a list of predetermined
categories: grocery shopping, shopping, banking, library/post office,
restaurant, salon/barber, recreational and ‘other’. In the ‘other’ category of
activities, participants were asked to describe activities that did not fit
into the categories provided. Participants were asked to report factors
influencing the outdoor activity participation in summer and winter in addition
to those mentioned in the questionnaire. Additionally, our questionnaire
captured the subjective functional challenges experienced by participants
living with spasticity, and its possible influence on the types and durations
of outdoor activities in winter and summer (see Appendix 1).
A
questionnaire was the most suitable method of data collection because it
provided a multitude of questions measuring the stated quantitative and
qualitative variables[19]. The questionnaire employed close-ended
questions as well as open ended questions. The close ended questions, in which
response categories were provided, were used to reduce ambiguity and aid
statistical analysis[19], while open-ended questions provided
in-depth participant views, attitudes and suggestions allowing the researchers
to probe and develop new insights[19] into outdoor activity
participation of participants.
To measure the severity of
spasticity, the questionnaire used an 11-point numeric rating scale (NRS; 0 =
no spasticity, 10 = worst possible spasticity) that has been found to be
correlated with clinical assessments of spasticity in people with UMN lesions[20-22].
Procedure
Primary researchers explained the purpose of the study and obtained and
documented verbal consent. Participants were informed that they could withdraw
from the study at any point. The questionnaire took up to 30 minutes to
complete and was administered over the phone. Participants were encouraged to
follow along using their copy of the questionnaire, and participant responses
were documented. Data was collected over a two month period.
Data analysis
Quantitative
analysis: Participants were asked to approximate the average duration of total
outdoor activity on a typical summer and winter day. Differences in duration of
outdoor activities between summer and winter were compared using a parametric
paired t-test. Pearson’s correlation was used to assess relationship
between UE and LE spasticity severity and duration of outdoor activities in
winter and summer. Statistically significant findings were defined at p
<0.05. All data analysis was completed using the IBM SPSS version 20
(Statistical Package for Social Sciences, IBM Corporation, New York, NY) and
Microsoft Excel add-on (XL Toolbox © 2008-2011 Daniel Kraus, Würzburg,
Germany).
Qualitative analysis: The two primary
researchers analyzed participant responses to the open ended questions
regarding types of and barriers to outdoor activities using an inductive
content-analysis approach[23]. Participant responses about types of
and barriers to outdoor activities were coded based on key concepts, clustered
into themes which were then refined into meaningful patterns of participants’
engagement. Outdoor activity categories on our questionnaire were thematically
analyzed into life-maintenance needs (medical visits, grocery shopping,
shopping, employment, and banking) and life-enhancing needs (salon/barber,
restaurants and 'other' activities – recreational, social, and cultural).
Results
Participants
Participants (n=30): thirteen stroke, 8 SCI, 5 TBI, and 4 MS. A
summary of participant demographics can be found in table 1.
Durations of
outdoor activities
Participants reported spending an average time (±SD) of 227 ±180 minutes
outdoors on a summer day, which is equivalent to 16% of a 24-hour day.
Participant responses ranged from 10 – 600 minutes. The average time spent
outdoors on a winter day was 62±57 minutes, with participant
responses ranging from 0-180 minutes. This is equivalent to 4% of a 24-hour
day. Thus, time spent outdoors on a summer day was four times the duration of
time spent outdoors on a winter day which was statistically significant,
p<0.01 (degrees of freedom 29), as determined by a t-test. Average seasonal
temperatures in winter were 4.8±6.8℃ (high) and
-3.3±5.8℃ (low) and in summer were 26.8±4.4℃ (high) and
16.4±3.7℃ (low). (Environment Canada, 2011)
Types of
outdoor activities
More participants reported engaging in life-enhancing activities in
summer (70%) than in winter (40%); particularly 'other' activities. Participant
responses in the ‘other’ activities category tended to be activities that were
leisurely including escape activities such as going to the park and reading
outdoors; cultural activities such as attending church; social activities such
as spending time with family or friends or volunteering.
Duration by
types of outdoor activities
The average duration of outdoor activities (Figure 1) was similar for
most categories of outdoor activities between summer and winter. The biggest
difference in average duration was found in the 'other' category of outdoor
activities (90 minutes/day in summer; 20 minutes/day in winter).
Relationship
between spasticity and duration of outdoor activities in winter
Sixty-one percent of participants reported that their spasticity
increased in winter compared to summer, contributing to less time spent
outdoors in winter. Although the average self-reported UE and LE spasticity was
similar (see table 1), UE spasticity severity was found to be negatively
correlated with the amount of time spent outdoors in winter (Pearson’s r
=-0.39, p=0.016) (See figure 2). LE spasticity was not correlated with
time spent outdoor in winter, r =0.030 (p=0.437).
Extrinsic
barriers to outdoor activity engagement
An extrinsic barrier is a theme that emerged from participants
discussing challenges to outdoor activity engagement. Based on participant
responses, social, structural, service, and seasonal barriers were identified
as the four major categories hindering outdoor activity participation.
Respondents
identified social challenges such as the unavailability of caregiver for
assistance with outdoor mobility or transportation in winter. This finding was
supported by our quantitative analysis which revealed that 43% of participants
required assistance of another individual in winter, compared to 33% in summer.
Additionally, structural barriers such as unavailability of ramps or sidewalks
were also reported to be an impediment to outdoor activity participation.
While both social and structural barriers remained relatively
consistent throughout both seasons, participants reported that extreme
temperature, snowfall, accumulated snow, and slippery icy surfaces hindered
outdoor mobility in winter. These reported seasonal difficulties are captured
in two representative statements below:
(1)
Participant # 22: “I avoid going outside when it’s snowy and icy unless I
absolutely have to...in that case I try to limit it to one day a week. Summer
is my get out of jail free card.”
(2)
Participant # 9: “I need to wait until a path has been cleared before I can get
through. Chunks of ice and snow on sidewalks is a hazard. I broke the frame of
my chair hitting a chunk of ice. The salt rusts parts of my wheelchair.”
Additionally,
participants reported challenges to accessing public transportation services.
Participants used multiple transportation services in both summer and winter
since mobility method varied depending on the proximity and travel time to the
destination, as well as the seasonal conditions. Forty percent of participants
reported using public transportation to a local destination when weather
conditions were poor. Seventy three percent reported taking a public
door-to-door accessible transit service provided by the city for persons with
physical disabilities, 76% walked or used wheelchair/scooter, and 63% were
transported by car; these modes of transportation were unaffected by weather.
Therefore, mode of transportation depended on environmental conditions and
locale. These challenges expressed by participants in winter may have adversely
contributed to the duration of time spent on outdoor activities. Furthermore,
many participants had inadequate information about resources available to them–
such as online banking and web-based grocery services.
Discussion
Durations and
types of outdoor activities
The main finding of our study was that the time spent outdoors was 4
times less in winter than in summer in persons with spasticity. Merchant et
al (2007) found that in the winter 64% of the non-neurological population
was inactive compared to 49% in summer. Thus, the seasonal differences in
activity levels appear to be greater amongst participants with spasticity
compared to non-neurological healthy population. These differences in outdoor
activities may be related to perceived spasticity levels because of significant
negative correlation between arm spasticity and time spent outdoors. In
addition to factors that influence inactivity amongst the non-neurological
population, such as adverse weather conditions, individuals with spasticity may
face additional physiological and environmental obstacles.
The necessity
and pertinence of activities was a theme that emerged from participants’
prioritizing life-maintenance activities over life-enhancing activities.
Interestingly, the time spent on life-maintenance outdoor activities did not
vary significantly between the two seasons suggesting that these activities
were prioritized and completed regardless of the difficulties that these
individuals faced during colder temperatures.
Additionally,
longer duration of time was spent participating in leisure-time
(life-enhancing) outdoor activities in summer. Merchant et al (2007)
found that leisure-time activity was 86% more likely to occur in summer than in
winter in a non-neurological population. Similarly, Perrier et al (2012)
found that individuals with SCI, much like the general population, were less
likely to report engaging in leisure-type activity during winter. Therefore,
our findings are supported by previous literature showing that leisure activity
is prioritized when weather conditions are favorable.
Our findings
are also in agreement with Carp (1988), who highlighted the motivations of
individuals to satisfy life-maintenance needs[24] such as
nourishment, clothing, medical care, before meeting life-enhancing needs, such
as social interaction, recreation (leisure-type activities), and religious
experience. Although life-enhancing needs tend to be devalued, they are
essential to achieve acceptable quality of life, allowing individuals to build
social relationships, experience positive emotions, and acquire additional
skills and knowledge[25].
Relationship
between spasticity severity/location and outdoor activities
Similar to Shirado et al[8] (1995), spasticity was
reported to be worse in winter in our study. Anecdotal reports also indicate
that children who experienced recurrent strokes also demonstrated increased
spasticity due to cold weather[26]. Additionally, external stimuli
such as a cold breeze[27] or air conditioning[28] have
also been found to trigger spasticity. Thus, our findings are congruent with
past studies.
The present
study found that high UE spasticity was related to decreased time spent
outdoors in winter. The relationship between UE spasticity and decreased time
spent outdoors can be explained by the requirement of upper extremities for
ambulation with or without a mobility device[29]. Majority of
participants in our study sample relied on seated mobility devices, indicating
that LE function was not the main contributor towards ambulation. Those with
higher UE spasticity severity would have difficulties operating their mobility
device with their hands and that can explain restriction of outdoor mobility in
winter. Additionally, UE dysfunction has been correlated with loss in quality
of life, which has been associated with limitations in the domains of
self-care, mobility and other meaningful activities[30]. A
relationship between leg spasticity and time spent outdoors in winter may not
have manifested due to fewer participants (38%) relying on locomotion involving
LE muscle activation. Future studies should further assess the individual
contribution of UE and LE spasticity on time spent outdoors using multiple
regression models.
Limitations
This study employed subjective (rather than objective) measures to
determine the duration of outdoor activities. The perception of spasticity may
be influenced by pain, personal interpretations, and coping strategies[28].
Additionally, participants may overestimate or underestimate true activity
levels, thus compromising the validity and reliability of results. While a
cross-sectional method was appropriate because subjective measurements were
used, it was not ideal as perceived types and duration of physical activity
were not measured in summer and in winter each. Phone surveys were done in
winter months and since patients were asked to recollect their perceptions from
the past summer the summer perceptions (but not winter perceptions) may have
been affected by recall bias. Additionally, this study did not explore the
frequency at which activities were performed during the two seasons. Although,
participants may spend similar durations of time completing life-maintenance
activities during the winter and summer, these activities may have been
completed less frequently in winter than in summer.
Objective
measures (such as a timer or step monitors), in combination with self-report
would be optimal for comparison of winter and summer outdoor activities.
Although elements of the questionnaire were validated (NEWS categories and
spasticity assessment), the questionnaire in its entirety was not validated.
Future studies should examine the relationship between LE spasticity and
duration of outdoor activity, employ objective and subjective measures, and
explore both duration and frequency of outdoor activities in winter and summer.
Conclusions
This pilot study revealed that adults with spasticity spent less time
engaging in life-enhancing needs in winter compared to summer. Spasticity, more
specifically UE spasticity, may be the main contributing factor accounting for
the reduced duration of outdoor activity observed between the seasons. The
contribution of spasticity compared to other signs of UMN lesions such as
impaired motor control and muscle weakness remains to be studied. While social
and structural barriers were present throughout both seasons, seasonal barriers
specifically hindered participation in winter outdoor activities. Further
exploration of seasonal and functional outdoor needs of adults with spasticity
will inform best practice of care for adults with spasticity, particularly in
North America and other countries close to the Polar regions where seasonal
changes are drastic.
Acknowledgments
We would like to thank the West Park Foundation, all of our
participants for their time, and the staff at the Comprehensive Spasticity
Management Clinic in West Park Healthcare Centre. We would also like to thank
the School of Graduate Studies at the University of Toronto for a travel grant
to share our findings at the 2013 Annual Conference of the Canadian Association
of Occupational Therapists, held in Victoria, BC.
CONFLICT OF INTERESTS
The authors have no conflicts of interest to declare.
REFERENCES
1
Pandyan, A., et al., Spasticity:
Clinical perceptions, neurological realities and meaningful measurement.
Disability \& Rehabilitation, 2005. 27(1-2): p. 2--6.
2
Bavikatte, G., T.G.G. Bavikatte, and T.
Gaber, Approach to spasticity in general practice. British Journal of Medical
Practitioners, 2009. 2(3): p. 29-34.
3
Watkins, C.L., et al., Prevalence of
spasticity post stroke. Clin Rehabil, 2002. 16(5): p. 515-22.
4
Rizzo, M.A., et al., Prevalence and
treatment of spasticity reported by multiple sclerosis patients. Mult Scler,
2004. 10(5): p. 589-95.
5
Skold, C., R. Levi, and A. Seiger,
Spasticity after traumatic spinal cord injury: nature, severity, and location.
Arch Phys Med Rehabil, 1999. 80(12): p. 1548-57.
6
Surgeons, A.A.o.N. Spasticity:
Prevalence and incidence. 2006 [cited 2014 December 2nd];
Available from: http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Spasticity.aspx.
7
Aras, M.D., et al., Functional outcome
following traumatic brain injury: the Turkish experience. Int J Rehabil Res,
2004. 27(4): p. 257-60.
8
Shirado, O., et al., Outdoor winter
activities of spinal cord-injured patients. With special reference to outdoor
mobility. Am J Phys Med Rehabil, 1995. 74(6): p.
408-14.
9
Tanaka, M., et al.,
Reflex activation of rat fusimotor neurons by body surface cooling, and
its dependence on the medullary raphe. J Physiol, 2006. 572(Pt 2): p. 569-83.
10 McCullough,
L. and S. Arora, Diagnosis and treatment of hypothermia. Am
Fam Physician, 2004. 70(12): p. 2325-32.
11 Boyd,
R.N., M.E. Morris, and H.K. Graham, Management of upper limb dysfunction in
children with cerebral palsy: a systematic review. Eur J Neurol, 2001. 8 Suppl
5: p. 150-66.
12 Kheder,
A. and K.P. Nair, Spasticity: pathophysiology, evaluation and management. Pract
Neurol, 2012. 12(5): p. 289-98.
13 Merchant,
A.T., M. Dehghan, and N. Akhtar-Danesh, Seasonal variation in leisure-time
physical activity among Canadians. Can J Public Health, 2007. 98(3): p. 203-8.
14 McColl,
M.A., et al., International differences in ageing and spinal cord injury.
Spinal Cord, 2002. 40(3): p. 128-36.
15 Dasgupta,
K., et al., Walking behaviour and glycemic control in type 2 diabetes: seasonal
and gender differences--study design and methods. Cardiovasc Diabetol, 2007. 6:
p. 1.
16 Borkan,
J.M., Mixed methods studies: a foundation for primary care research. Ann Fam Med, 2004. 2(1): p. 4-6.
17 Creswell,
J.W. and V.L. Piano Clark, Understanding mixed methods research, in Designing
mixed methods research2007, Sage Publications. p. 273.
18 Saelens,
B.E., et al., Neighborhood-based differences in
physical activity: an environment scale evaluation. Am
J Public Health, 2003. 93(9): p. 1552-8.
19 Rowley,
J., Designing and using research questionnaires rowley. Management Research
Review, 2014. 37(3): p. 308-330.
20 Anwar,
K. and M.P. Barnes, A pilot study of a comparison between a patient scored
numeric rating scale and clinician scored measures of spasticity in multiple
sclerosis. NeuroRehabilitation, 2009. 24(4): p. 333-40.
21 Farrar,
J.T., et al., Validity, reliability, and clinical importance of change in a 0-10
numeric rating scale measure of spasticity: a post hoc analysis of a
randomized, double-blind, placebo-controlled trial. Clin Ther, 2008. 30(5): p.
974-85.
22 Sköld,
C., Spasticity in spinal cord injury: self- and clinically rated intrinsic
fluctuations and intervention-induced changes. Arch Phys Med Rehabil, 2000.
81(2): p. 144-9.
23 Graneheim,
U.H. and B. Lundman, Qualitative content analysis in nursing research:
concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today,
2004. 24(2): p. 105-12.
24 Carp,
F.M., Significance of mobility for the well-being of the elderly.
Transportation in an Aging Society: Improving Mobility and Safety of Older
Persons, 1988. 2: p. 1-20.
25 Brajša-Žganec,
A., M. Merkaš, and I. Šverko, Quality of life and leisure activities: How do
leisure activities contribute to subjective well-being? Social Indicators
Research, 2011. 102(1): p. 81-91.
26 Baxter,
P., et al., Congenital livedo reticularis and recurrent stroke-like episodes.
Dev Med Child Neurol, 1993. 35(10): p. 917-21.
27 Little,
J.W., et al., Lower extremity manifestations of spasticity in chronic spinal
cord injury. Am J Phys Med Rehabil, 1989. 68(1): p.
32-6.
28 Mahoney,
J.S., et al., Spasticity experience domains in persons with spinal cord injury.
Arch Phys Med Rehabil, 2007. 88(3): p. 287-94.
29 Milosevic,
M., K.M. McConville, and K. Masani, Arm movement improves performance in
clinical balance and mobility tests. Gait Posture, 2011. 33(3): p. 507-9.
30 de
Putter, C.E., et al., Health-related quality of life after upper extremity
injuries and predictors for suboptimal outcome. Injury, 2014. 45(11): p.
1752-8.
Peer reviewer: Fang
Li, MD, PhD, Department of Rehabilitation Medicine, Huashan Hospital, Fudan
University, Shanghai, 200040, China.
Appendix 1: Outdoor Activities in
Winter and Summer Questionnaire
Date: Subject#: Time since stroke (years): Age:
Weak side:
1) Where is your spasticity?
Arm
Legs
Both
Not Applicable
2) How much is your spasticity
(muscle tightness) on a scale of 0 – 10 (0= no spasticity and 10=you cannot
move your limb)? _________
3) Do you use devices to help you move around?
Wheelchair
Walker
Cane None
4) Do you have other conditions that limit your mobility
outside? ______________________
5)Does spasticity affect your ability to do outdoor
activities? Yes No
6) Are you more active in summer than winter? Yes No No
Difference
Refbacks
- There are currently no refbacks.