Physical therapy in patients with disorders of consciousness: Impact on spasticity and muscle contracture

Thibaut, Aurore; Wannez, Sarah; Deltombe, Thierry; Martens, Géraldine; Laureys, Steven; Chatelle, Camille

doi:10.3233/nre-172229

Cited by 31 publications

(40 citation statements)

References 25 publications

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“…O plano de intervenção foi elaborado a partir da revisão teórica e comporta exercícios de mobilização articular realizados diariamente com avaliação por goniometria antes e após cada sessão (18)(19)(20)(21) .…”

Section: Methodsunclassified

Manter a mobilidade articular no doente critico: estudo de caso

Beliz

Bule

Sousa

2020

RPER

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Introdução: A imobilidade no doente crítico é condicionada pela condição de doença ou ainda, pelo efeito de fármacos, mas, em ambos os casos, emerge como um problema na perspetiva da recuperação funcional. A diminuição da massa muscular e da amplitude articular atrasam ou dificultam os processos de recuperação da ventilação espontânea e os autocuidados. Quando o repouso no leito se impõe, os cuidados de enfermagem de reabilitação seguros são um recurso com vista à mitigação dos problemas associados à imobilidade. Objetivo: Avaliar resultados dos cuidados de enfermagem de reabilitação após a aplicação de uma intervenção estruturada de cuidados de mobilização articular passiva em doente crítico. Método: Estudo qualitativo, tipo estudo de caso. É apresentado o caso de uma pessoa adulta em situação crítica á qual foram realizadas oito sessões de mobilização articular por enfermeiro de reabilitação. Avaliada a amplitude articular com recurso a goniometria antes e após a aplicação de um programa de reabilitação. Estudo aprovado em comissão de ética. Resultados: Verificou-se que em 26 dias de internamento em unidade de cuidados intensivos a amplitude articular se manteve nos diferentes segmentos e houve ganhos nos movimentos de supinação do antebraço, extensão da mão esquerda e flexão do joelho direito. A realização de exercícios passivos de mobilização articular não interferiu com a estabilidade de parâmetros fisiológicos ou de adaptação à prótese ventilatória. Conclusões: Os resultados revelam a não ocorrência de diminuição da amplitude articular e são sensíveis aos cuidados de enfermagem de reabilitação, num plano estruturado e regular de mobilizações. Houve ganhos em saúde e a minimização das complicações associadas à imobilidade. Outros estudos devem ser realizados no sentido de parametrizar não só o plano de intervenção bem como a evidência dos resultados obtidos. Descritores: Cuidados Intensivos, Enfermagem de Reabilitação, Acamado, exercícios terapêuticos

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Section: Methodsunclassified

Manter a mobilidade articular no doente critico: estudo de caso

Beliz

Bule

Sousa

2020

RPER

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“…Many patients with severe brain injury and disorders of consciousness (DOC) are affected by spasticity, whose treatment is a challenge [1,2]. Voluntary movements and collaboration are usually limited if not absent in this population [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…Treatments are often limited to passive physical therapy (e.g., conventional stretching or tilt table [5]) or pharmacological interventions such 21 as anti-spastic drugs (e.g., baclofen, rivotril, sirdalud) or botulinum 22 toxin injections, as prescribed for other neurological conditions 23 such as stroke (for review see [6]). In addition, the patients' 24 condition aggravates the symptoms because of inactivity and 25 positioning; hence, a high proportion of patients with DOC have 26 severe hypertonia: 89% present signs of hypertonia on a least one 27 segment, and 61.5% have severe hypertonia (i.e., score of 3 or more 28 on the Modified Ashworth Scale [MAS]) [1].…”

Section: Introductionmentioning

confidence: 99%

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Effect of multichannel transcranial direct current stimulation to reduce hypertonia in individuals with prolonged disorders of consciousness: A randomized controlled pilot study

Thibaut

Piarulli

Martens

et al. 2019

Annals of Physical and Rehabilitation Medicine

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Background: Spasticity management in severely brain-injured patients with disorders of consciousness (DOC) is a major challenge because it leads to complications and severe pain that can seriously affect quality of life. Objectives: We aimed to determine the feasibility of using transcranial direct current stimulations (tDCS) to reduce spasticity in chronic patients with DOC. Methods: We enrolled 14 patients in this double-blind, sham-controlled randomized crossover pilot study. Two cathodes were placed over the left and right primary motor cortex and 2 anodes over the left and right prefrontal cortex. Hypertonia of the upper limbs and level of consciousness were assessed by the Modified Ashworth Scale (MAS) and the Coma Recovery Scale-Revised (CRS-R). Resting state electroencephalography was also performed. Results: At the group level, spasticity was reduced in only finger flexors. Four responders (29%) showed reduced hypertonicity in at least 2 joints after active but not sham stimulation. We found no behavioural changes by the CRS-R total score. At the group level, connectivity values in beta2 were higher with active versus sham stimulation. Relative power in the theta band and connectivity in the beta band were higher for responders than non-responders after the active stimulation. Conclusion: This pilot study highlights the potential benefit of using tDCS for reducing upper-limb hypertonia in patients with chronic DOC. Large-sample clinical trials are need to optimize and validate the technique.

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“…The effect of stretching exercises as part of the rehabilitation program for patients with spinal cord injury consequences that interfere with the efficacy of the rehabilitation program and increase the degree of disability (2,(10)(11)(12). The pathogenesis of spasticity following SCI is not completely understood.…”

Section: Introductionmentioning

confidence: 99%

The effect of stretching exercises as part of the rehabilitation program for patients with spinal cord injury

Mureșan

Pielmusi

Dumbravă

et al. 2019

BALNEO

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Introduction & objectives: Spinal cord injury is a neurological condition with a devastating impact on all aspects of patients’ life. Spasticity, a symptom of the resulting pyramidal syndrome, can be both beneficial and non-beneficial, and requires treatment when it causes significant limitations and complications. The therapeutic approach comprises a wide variety of therapies ranging from non-invasive to invasive procedures. One of the non-invasive procedures is physiotherapy including stretching exercises. There are several studies investigating the effects of stretching on spasticity but with inconclusive results, slightly favoring a positive effect. The aim of this case-control study was to evaluate the effect of a stretching module added to the specific physiotherapy program for patients with SCI. Material and method: An observational case-control study was conducted which included 20 patients with SCI attending a motor neurorehabilitation program for 10 consecutive days at the Rehabilitation Hospital Cluj-Napoca and “Dorina Palace” Center, Cluj-Napoca, during the years 2016-2017. The patients were divided into 2 groups of 10 patients each: the control group, which received specific physiotherapy and occupational therapy, and the study group, in which a stretching exercise module was added to the rehabilitation program (attended by the control group). The patients were assessed using the Modified Ashworth Scale, the Range of Motion (ROM) test for the lower limb joints, and the Ten Meter Walk Test, both at the beginning and at the end of the 10-days rehabilitation program. Results & discussions: The patients in the study group had statistically significant improvements in all the assessed scores compared to the control group, in which improvements were also present, but at the limit of statistical significance. Conclusion: The inclusion of stretching exercises in the specific physiotherapy program for patients with spastic paraparesis after spinal cord injury seems to have a short-term favorable impact, by reducing spasticity and improving ambulation. Key words: spinal cord injury, spasticity, stretching,

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Physical therapy in patients with disorders of consciousness: Impact on spasticity and muscle contracture

Cited by 31 publications

References 25 publications

Manter a mobilidade articular no doente critico: estudo de caso

Manter a mobilidade articular no doente critico: estudo de caso

Effect of multichannel transcranial direct current stimulation to reduce hypertonia in individuals with prolonged disorders of consciousness: A randomized controlled pilot study

The effect of stretching exercises as part of the rehabilitation program for patients with spinal cord injury

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