Affiliations: [a] Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium
| [b] Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| [c] Post-Coma Unit and Neurorehabilitation, IRCCS Fondazione Santa Lucia, Rome, Italy
| [d]
Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
Correspondence:
[*]
Address for correspondence: Aurore Thibaut. E-mail: athibaut@uliege.be.
Abstract: BACKGROUND:Following a severe acquired brain injury, neuro-orthopaedic disorders are commonplace. While these disorders can impact patients’ functional recovery and quality of life, little is known regarding the assessment, management and treatment of neuro-orthopaedic disorders in patients with disorders of consciousness (DoC). OBJECTIVE:To describe neuro-orthopaedic disorders in the context of DoC and provide insights on their management and treatment. METHODS:A review of the literature was conducted focusing on neuro-orthopaedic disorders in patients with prolonged DoC. RESULTS:Few studies have investigated the prevalence of spastic paresis in patients with prolonged DoC, which is extremely high, as well as its correlation with pain. Pilot studies exploring the effects of pharmacological treatments and physical therapy show encouraging results yet have limited efficacy. Other neuro-orthopaedic disorders, such as heterotopic ossification, are still poorly investigated. CONCLUSION:The literature of neuro-orthopaedic disorders in patients with prolonged DoC remains scarce, mainly focusing on spastic paresis. We recommend treating neuro-orthopaedic disorders in their early phases to prevent complications such as pain and improve patients’ recovery. Additionally, this approach could enhance patients’ ability to behaviourally demonstrate signs of consciousness, especially in the context of covert awareness.
Keywords: Coma, spasticity, rehabilitation, motor function, traumatic brain injury, vegetative state, minimally conscious state
