There is a relatively high prevalence of shoulder pain after traumatic brain injury. Trauma to the shoulder complex contributes to shoulder pain after traumatic brain injury, making clinical presentation different from people with stroke. The findings support the need for greater attention in the management of shoulder pain after traumatic brain injury.
With appropriate support, extra practice outside therapy sessions is generally feasible to maximize training opportunity for patients with traumatic brain injury. Motivation, perception of being listened to, executive functioning and severity of injury are factors that influence participation in extra practice. Strategies that improve motivation, interaction and confidence are likely to enhance participation. Relatives are a useful source of support for the more dependent patients.
Objective:
To determine the effectiveness of a programme comprising serial casting, botulinum toxin, splinting and motor training in contracture management.
Design:
A randomized trial with concealed allocation and assessor blinding, a deferred treatment cross-over design within the control group, was conducted.
Setting:
Inpatient Brain Injury Unit of a rehabilitation centre.
Subjects:
A total of 10 patients with severe acquired brain injury (13 ankles).
Interventions:
The intervention group received botulinum toxin and then serial casting. The control group was placed on a wait list for six weeks (control phase) and then received the same interventions as the intervention group (intervention phase). Both groups received splinting and motor training following serial casting.
Main measures:
The primary outcome was passive ankle dorsiflexion range. Secondary outcomes included spasticity, ankle dorsiflexor strength, Functional Independence Measure score for the walking item and walking speed.
Results:
The mean between-group difference for passive ankle dorsiflexion range at completion of casting was 26° (95% confidence interval (CI): 17–35); at Week 2, after casting was 24° (95% CI: 14–33). The mean within-group differences for passive ankle dorsiflexion at completion of casting, Week 2 after casting and Week 8 after casting were 26° (95% CI: 20–31), 26° (95% CI: 18–33) and 24° (95% CI: 19–30), respectively. These improvements were sustained at Week 2 and Week 8 after casting.
Conclusions:
A programme for contracture management comprising serial casting, botulinum toxin, motor training and splinting can be useful in improving joint range.
The high satisfaction of the patients and relatives suggests that our brain injury unit provides physiotherapy that meets their expectations. Promoting recovery, providing high-quality care, and ensuring good interaction are ways to maintain high satisfaction of patients and relatives with the service. In addition, staff may have to pay particular attention to patients' satisfaction with the amount of therapy and ensure that relatives' needs are listened to.
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