24 Chapter 2 in physical activity (figure 2). The same trend was seen for balance impairments (χ2(1)=3.291, p=0.070). Those who reported increased levels of psychological stress more often reported an increase in muscle stiffness (χ2(1)=4.612, p=0.032), pain (χ2(1)=3.943, p=0.047), and mental fatigue (χ2(1)=6.234, p=0.013). Forward regression analysis of muscle stiffness and pain revealed that only decreased physical activity was independently associated with an increase in muscle stiffness (R2=0.222 (p<0.001) and pain (R2=0.193 (p=0.003)). Six participants were treated with intramuscular botulinum toxin injections to reduce spasticity-related symptoms. During the lockdown, treatment continued in five participants. Figure 1. The impact of the COVID-19 partial lockdown measures on spasticity-related symptoms in people with pure HSP. Participants reported whether the experienced symptom severity increased (mild or strong), decreased (mild or strong) or did not change. Only participants who experienced a specific symptom (either before or after the lockdown) are included in the figure.
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