1. RESULTS Study 2 – Results Seasonal variation in spasticity, botulinum toxin dose, outdoor activities and associated barriers Sachindri Wijekoon 1, Kim-Mihn Tran-Nguyen 1, Lisa Martin 1, Martha Miller 1, Farooq Ismail 1, 2, Chris Boulias 1, 2, Lisa Lyons 1, 2, Chetan P. Phadke 1, 2, 3, 1-University of Toronto; 2-Spasticity Research Program, West Park Healthcare Centre; 3-York University, Toronto, Ontario, CANADA Spasticity is a velocity dependent increase in muscle tone, and is associated with a variety of upper motor neuron lesions. Spasticity can cause reduced range of motion, pain, stiffness, and loss of function 1, all of which could decrease the ability to participate in meaningful occupations. Since spasticity can worsen in winter 2, it is conceivable that seasonal changes may affect the outdoor activities of adults with spasticity. However, there is little research to support this notion. Spasticity is often treated using intra ‐ muscular botulinum toxin-A injections (BoNTA). Previous reports of worsening of spasticity in cold weather suggest that spasticity levels and botulinum toxin dose may both be influenced by seasonal temperature changes. INTRODUCTION Study 1: 30 adults with spasticity (13 CVA, 8 SCI, 5 brain injury and 4 MS) completed the Outdoor Activities in Winter and Summer phone questionnaire. 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 spasticity severity and duration of outdoor activities in winter and summer. Participant responses about types of and barriers to outdoor activities were thematically analyzed. Study 2: Medical charts of 132 patients receiving BoNTA treatments in an outpatient spasticity clinic were reviewed. Age, sex, diagnosis, number of muscles injected, spasticity level, as measured by the Modified Ashworth Scale, and BoNTA dose were collected for summer and winter. Spasticity and BoNTA dose was compared between summer and winter using separate paired t-tests (p<0.05) for each diagnostic group. METHODS. OBJECTIVES Study 1: To explore the perceived differences in duration and types of outdoor activities performed in winter and summer conditions in adults with upper extremity (UE) and lower extremity (LE) spasticity To explore barriers to outdoor activities in winter and in summer encountered by adults with spasticity Study 2: To determine the effect of seasonal temperature variation on spasticity level, as measured by the Modified Ashworth Scale. To determine the effect of seasonal temperature variation on BoNTA dosage. ACKNOWLEDGMENTS We would like to thank all our participants, the West Park Foundation, and the West Park Spasticity Management Clinic staff. Study 1 – Results Study 1- The seasonal differences in activity levels are greater amongst participants with spasticity compared to non-neurological healthy population. Life-maintenance outdoor activities were prioritized and completed regardless of the difficulties faced during colder temperatures, while life-enhancing needs were devalued despite being essential to achieving acceptable quality of life. High UE spasticity is related to decreased time spent outdoors in winter. LE spasticity had little influence on winter outdoor activity duration due to reliance on wheelchairs as opposed to leg muscle activity such as walking. DISCUSSION REFERENCES 1.Perry, J., Determinants of muscle function in the spastic lower extremity. Clinical orthopaedics and related research, 1993 (288): p. 10-26. 2.Cheung J, Hoang J, DiPoce S, Rancourt A, Levine A, Ismail F, Boulias C, Phadke CP. Patient identified factors that influence spasticity in individuals with stroke and multiple sclerosis who are receiving botulinum toxin injection treatments. Physiother Can. 2015 Spring;67(2):157-66 NumberN = 30 FemaleN = 10 MaleN = 20 Walkers*N = 11 Non-walkers*N = 19 Mean + SDRange Age (years) 56 ± 1625-87 Duration of lesion (years) 08 ± 071-27 Spasticity severity in arm 05 ± 03 1-10** Spasticity severity in leg 05 ± 03 1-10** *Walkers - those who ambulate with a walker, cane or independently. Non-walkers - those using a power/ manual wheelchair, or scooter for mobility. **1=no spasticity, 10=cannot move limb Figure 1. Percentage of time spent outdoors in a 24 hour day. Time spent outside was significantly higher in summer than winter (p < 0.001). Figure 2. Types and duration of outdoor activities of patients with spasticity during the winter and summer Table 1: Demographic characteristics of study participants Figure 3. Negative correlation between severity of arm spasticity and the amount of time spent outdoors in the winter (r = - 0.39, p=0.016) CVAMSCP Total subjects Number of Participants 603438132 Age range 27-8828-7919-6919-88 Mean age 66.6056.8837.0555.59 % Female 46.67%70.59%42.11%51.52% % Male 53.33%29.41%57.89%48.48% Average body weight - Summer (Kg) 76.3064.7867.0271.29 Average body weight - Winter (Kg) 79.7671.4259.4271.48 Average total # muscles injected - Summer 6.365.855.956.11 Average total # muscles injected - Winter 6.435.725.666.03 Table 1: Demographic characteristics of study participants While social and structural barriers remained relatively consistent throughout winter and summer and hindered participation, environmental barriers particularly hindered winter outdoor mobility. Study 2- Seasonal temperature variations were found to have no effect on either spasticity as measured by the Modified Ashworth Scale, or BoNTA dosage. A limitation of this study was that patients’ winter spasticity levels were measured after patients had been sitting in a heated waiting room from 10-30 minutes. Since the body was allowed to warm up, the effect of winter temperature on spasticity may have dissipated. Conclusion Particular emphasis should be placed on management of spasticity, education, and advocacy to enhance outdoor activity engagement during the winter. UE spasticity treatment should be particularly more aggressive during the winter. Future studies should determine the relationship between LE spasticity and time spent outdoors in the winter. Additionally, spasticity measurements should be taken in temperature controlled rooms to mimic seasonal temperature variations more accurately.