NeuroRehabilitation - Volume 12, issue 2

Authors: H. Mayer, Nathaniel

Article Type: Introduction

DOI: 10.3233/NRE-1999-12201

Citation: NeuroRehabilitation, vol. 12, no. 2, pp. 79-80, 1999

Authors: Laborde, Andrea T. | Weibel, M.E. | Meythaler, Jay | Narayan, Raj

Article Type: Research Article

Abstract: This article provides an overview of the use of intrathecal baclofen in the treatment of spasticity due to cerebral origin. Oral and intrathecal uses of baclofen are compared. The unique pharmacological properties of baclofen which make it ideal for intrathecal use are discussed. Historical development of the treatment in both spinal and cerebral spasticity is presented. Technical aspects (performing trials, surgical insertion, and maintenance) and complications of treatment are reviewed. Through the use of case studies selection of candidates and concomitant treatment options are explored

Keywords: baclofen, infusion pump, intrathecal injection, spasticity, traumatic brain injury

DOI: 10.3233/NRE-1999-12202

Citation: NeuroRehabilitation, vol. 12, no. 2, pp. 81-91, 1999

Authors: Gormley, Mark E.

Article Type: Research Article

Abstract: As in adults, spasticity of cerebral origin in children can interfere with function, cares, positioning, and comfort. Reducing spasticity may improve overall function. Many treatment modalities have been developed to treat spasticity in children. This article reviews some of these treatment options including bracing, physical and occupational therapy, oral medications, neurolytic blocks, neurosurgical procedures, and orthopaedic surgery. Specific characteristics of children which influence treatment will also be discussed. Most children benefit from a combination of treatments and not just a single treatment modality. The optimal treatment combination usually changes over time as a child grows and develops. Once the special …characteristics of children and the various treatment options are understood, the treatment of cerebral origin spasticity in children can be optimized. Show more

Keywords: spasticity, cerebral palsy, botulinum toxin, phenol, selective dorsal rhizotomy, intrathecal baclofen pump

DOI: 10.3233/NRE-1999-12203

Citation: NeuroRehabilitation, vol. 12, no. 2, pp. 93-103, 1999

Authors: Hunt Herman, Janice | Lange, Michelle L.

Article Type: Research Article

Abstract: Regaining function and independence after sustaining a brain injury is often complicated by abnormal muscle tone, particularly spasticity. A conservative, non-invasive, and relatively inexpensive treatment is therapeutic seating and positioning. To inhibit spasticity seating will need to address specific issues including: individualized optimum posture, neurophysiological techniques, primitive postural reflexes, abnormal movement patterns, proximal stability, pelvic stabilization, lower extremity position, upper trunk and head position, upper extremity position, orientation in space, dynamic equipment, sensory and visual disturbances, emotional and cognitive stress, physical work demand, discomfort and pain, and skin irritation. Despite the rehabilitation team's efforts to inhibit spasticity, it will persist …in many clients with head injury. Therapeutic seating and positioning also offers several techniques for accommodating unavoidable spasticity and for dealing with the long-term sequelae. In particular, seating will reduce the risk of deformities, accommodate existing fixed deformities, provide safety modifications, use durable heavy-duty equipment, and provide additional training to caregivers. Show more

Keywords: wheelchair seating, positioning, spasticity, brain injury

DOI: 10.3233/NRE-1999-12204

Citation: NeuroRehabilitation, vol. 12, no. 2, pp. 105-117, 1999

Authors: Keenan, Mary Ann | Mayer, Nathaniel H. | Esquenazi, Alberto | Pelensky, Jeanne

Article Type: Research Article

Abstract: This article describes a neuro-orthopacdic approach to the functional problems of patients with an upper motoneuron syndrome after acquired brain injury. Typical patterns of upper motoneuron deformity are diagnostically evaluated to identify which muscles contribute dynamically and statically to observed deformity and impaired motor control. Dynamic EMG, gait and motion analysis and diagnostic nerve blocks frequently provide detailed information about specific muscle groups that guide neuro-orthopaedic decision making. Based on such information, neuro-orthopaedic procedures are done to improve passive and active function by rebalancing muscle forces that cause deformity and dysfunction across joints and limb segments.

Keywords: neuro-orthopaedic approach, impaired motor control, spasticity, contracture, upper motoneuron syndrome, dynamic EMG

DOI: 10.3233/NRE-1999-12205

Citation: NeuroRehabilitation, vol. 12, no. 2, pp. 119-143, 1999

Authors: Lazarus, Mark D. | Guttmann, Dan | Rich, Christopher E. | Keenan, Mary Ann E.

Article Type: Research Article

Abstract: We studied twenty-four patients (twenty-seven elbows) that underwent resection of heterotopic ossification about the elbow. All of the patients had suffered from a traumatic brain injury. In addition, eight of the patients suffered local trauma, either fracture or burn. All patients had surgery performed by one of two surgeons (MAK, MDL). The mean follow-up was 25.9± 2.6 months with a minimum of 12 months. Maximum flexion increased from 80.1 ± 7.8 degrees preoperative to 111.9± 4.5 degrees postoperative (p =0.0003). Maximum extension increased from 58.9 ± 6.2 degrees preoperative to 32.1 ± 5.3 degrees postoperative (p =0.0005). Twenty-three of …the 27 elbows gained motion, with 4 patients loosing an average of 15.0 ± 5.8 degrees. Interestingly, in the 17 patients who had ankylosed elbows preoperatively, the average gain in motion was 59.1 ± 10.6 degrees as compared to a gain of 23.2 ± 11.0 degrees in the remaining 10 patients (p =0.03). The time from injury until resection was a significant predictor of outcome, with longer times associated with worse outcome (p =0.02). Those patients who had continuous passive motion (CPM) after surgery had better motion gain (57.9 ± 4.3 degrees) than those that did not have CPM (24.1 ± 7.9 degrees) (p =0.04). Resection of heterotopic ossification about the elbow is effective in gaining motion in most patients. The surgery can be technically challenging and requires extensive preoperative planning. Patients who have greater loss of motion preoperatively (i.e., ankylosed) have better outcomes than those with less to gain. Continuous passive motion should be considered postoperatively as its use is associated with a better result. Show more

Keywords: heterotopic ossification, surgery for elbow heterotopic ossification, acquired brain injury

DOI: 10.3233/NRE-1999-12206

Citation: NeuroRehabilitation, vol. 12, no. 2, pp. 145-153, 1999