Development of muscle contractures and spasticity during subacute rehabilitation after severe acquired brain injury: a prospective cohort study

ABSTRACT

Objective: This study investigated the development of contractures, passive stiffness, and spasticity in the ankle joint in patients with severe acquired brain injury (ABI) from admission to rehabilitation unit until 1-year post-injury compared to healthy controls.

Design: An observational longitudinal cohort study

Methods and procedures: Nineteen patients (26 affected ankle joints) with severe ABI >17 years old and with paresis of a lower limb admitted to sub-acute neurorehabilitation were compared to 14 healthy controls (28 ankle joints). Passive and reflex-mediated ankle joint stiffness was obtained measuring torque, range of motion, velocity and acceleration of the ankle movements. Data was collected at inclusion, after 4–5 weeks, after 8–9 weeks and at 1-year follow-up.

Outcomes and results: At admittance to rehabilitation range of motion and stiffness was significantly lower compared to controls. Range of motion decreased by one degree in three weeks and passive ankle joint stiffness increased significantly by 1% per week. More patients than controls had no stretch reflex.

Conclusion: Patients with severe ABI show reduced mobility and increased passive stiffness despite less spasticity in the ankle joint compared to healthy controls. Research and clinical practice should therefore focus intensively on the prevention of contractures in the ankle joint. ISRCTN17910097

KEYWORDS:

• Muscle contracture
• spasticity
• severe acquired brain injury
• upper motor neuron syndrome

Acknowledgments

We would like to thank the patients who participated in the study and the staff at the Department of Neurorehabilitaiton, TBI Uni t at Rigshospitalet in Hvidovre for their assistance.

Declaration of interest

The authors report no conflict of interest

Additional information

Funding

This study was funded by Institut Produits Synthèse (IPSEN) AB and The Danish Physiotherapy Association. Equipment was provided by Movotec, Charlottenlund, Denmark.