People with spasticity in Carmarthenshire are the first in Wales to routinely receive ultrasound guided ‘Botox’ treatment at home.

This innovative approach to treatment has been made possible thanks to specially trained ‘advanced practice’ physiotherapists utilising new portable ultrasound technology.

Many people with neurological conditions, such as stroke, multiple sclerosis, cerebral palsy and spinal injury, experience muscle spasms (spasticity), which can cause pain and difficulty with day-to-day activities, such as washing and dressing. Botulinum toxin, commonly known as ‘Botox’, is a medical treatment that is injected directly into the effected muscles to relax them.

The gold standard for these injections is for them to be done using ultrasound guidance as it is more accurate, provides better results, and minimises risk of severe bleeding. Despite this, access to this procedure is very limited across the UK.

Due to COVID-19, patients were unable to come into hospital to have the treatment.

Gary Morris, Advanced Physiotherapy Practitioner at Hywel Dda UHB, said: “The pandemic meant we had to re-evaluate how we were going to support our patients. Traditionally people had to travel to a large hospital with the appropriate equipment to receive this treatment.

“The use of this low-cost portable technology means we can now effectively take the hospital to our patients. This innovation has been particularly important for people who have higher levels of disability where travel can be very difficult.

“Hywel Dda UHB is most certainly leading in this area, both nationally and internationally.”

Two people to have benefitted are Kirsty and Katheryn Fields. The 27-year-old twins from Llanelli have a neurological condition so rare it has been named after them: ‘Fields condition’. The twins both suffer for painful spasms and were among the first to receive the treatment at home.

Their mother and main carer Lyn said: “For both Kirsty and Kath to attend a hospital appointment there’s a huge amount of work involved, it can easily take 5 or 6 hours. The girls need 24/7 care at home so to do that while spending most of the day travelling and at the hospital means we need extra care to support them, it can be exhausting for all of us. Receiving the treatment in the comfort of their home and fitted around their care needs has been a massive benefit to us.”

Gary adds: “We are really pleased we can now provide this gold standard treatment to people with spasticity wherever they need it, be that a general hospital, community hospital, community clinic or in their own home.”

The handheld ultrasound from Healcerion, which connects to a tablet, was purchased for the service with the help of Hywel Dda Health Charities.

Nicola Llewellyn, Head of Hywel Dda Health Charities, said: “Donations to Hywel Dda Health Charities are helping to improve the experience of people with spasticity. We are very grateful to our communities who are so generous with the ways they choose to support their local NHS charity.”

Calum Higgins, Public Affairs and Policy Manager Wales for the Chartered Society of Physiotherapy, said: “As the professional body for physiotherapists we are keen to see the development of innovative community-based service for patients and developing the workforce advanced practice skills.

“The pandemic has accelerated change in this area and it’s great to see Hywel Dda developing a service that goes to the patient where they are and offering opportunities for the physio workforce to develop these advanced practice skills.”

Hywel Dda University Health Board has previously led in this field when it became the first organisation in Wales and one of the first in the world to utilise medicines prescribing by physiotherapists.

The health board is currently working in collaboration with Cardiff University and Kings College London, to develop international standards on the use of ultrasound guided injection of Botox. The research and development of this practice will aim to increase ultrasound guided injection in clinical practice.