The influence of illness duration and level of consciousness on the treatment effect and complication rate of serial casting in patients with severe cerebral spasticity
Restricted accessResearch articleFirst published online June, 2003
The influence of illness duration and level of consciousness on the treatment effect and complication rate of serial casting in patients with severe cerebral spasticity
Objective: To compare the improvement and complication rates for serial casting in patients with shorter as opposed to longer illness duration, and in patients with lower as opposed to higher levels of consciousness.
Design: A retrospective case-comparison study.
Setting: A rehabilitation centre for adult persons with neurological disorders.
Subjects: Sixty-eight patients with cerebral spasticity of different aetiologies were treated with serial casting to relieve fixed contractures.
Intervention: Serial casting with either <90 days (group A, 36 joints, 24 patients) or 390 days (group B, 85 joints, 44 patients) duration of illness and either <12 (group 1, 49 joints, 25 patients) or 312 (group 2, 72 joints, 43 patients) Glasgow Coma Scale (GCS) scores.
Main outcome measures: Percentage of normal maximum range of motion (ROM) at the completion of casting and one month after discontinuation, and number of complications due to casting procedure.
Results: No differences in ROM improvement between duration groups (F = 0.43, p = 0.51) and GCS groups (F = 1.3, p = 0.26) were observed. Complications in serial casting were found in 25.0% in group A, in 10.6% in group B (chi-squared = 4.2, p = 0.042), in 24.5% in group 1, and in 8.3% in group 2 (chi-squared = 6.0, p = 0.014).
Conclusion: This study suggests that serial casting in patients with longer illness duration and higher levels of consciousness provides improvements in ROM comparable with an earlier treatment in patients with more impaired consciousness, but results in a lower occurrence of complications.
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References
1.
Mayer NH, Esquenazi A, Keenan MAE. Analysis and management of spasticity, contracture, and impaired motor control. In: Horn LJ, Zasler ND eds. Medical rehabilitation of traumatic brain injury. Philadelphia: Hanley & Belfus, 1996: 411–458.
2.
O'Dwyer NJ, Ada L. Reflex hyperexcitability and muscle contracture in relation to spastic hypertonia. Curr Opin Neurol1996; 9: 451–455.
3.
O'Dwyer NJ, Ada L, Neilson PD. Spasticity and muscle contracture following stroke. Brain1996; 119: 1737–1749.
4.
Vattanasilp W, Ada L, Crosbie J. Contribution of thixotropy, spasticity, and contracture to ankle stiffness after stroke. J Neurol Neurosurg Psychiatry2000; 69: 34–39.
5.
Pohl M, Rückriem S, Mehrholz J et al. Effectiveness of serial casting in patients with severe cerebral spasticity: a comparison study. Arch Phys Med Rehabil2002; 83: 784–790.
6.
Freivogel S. Zirkuläre Gipsbehandlung. In: Freivogel S ed. Motorische Rehabilitation nach Schädelhirntrauma. Klinik - Grundlagen–Therapie. München: Richard Pflaum Verlag, 1997: 215–220.
7.
Pohl M, Rückriem S, Strik H et al. Treatment of pressure ulcers by serial casting in patients with severe spasticity of cerebral origin. Arch Phys Med Rehabil2002; 83: 35–39.
8.
Booth BJ, Doyle M, Montgomery J. Serial casting for the management of spasticity in the head-injured adult. Phys Ther1983; 63: 1960–1966.
9.
Conine TA, Sullivan T, Mackie T, Goodman M. Effect of serial casting for the prevention of equinus in patients with acute head injury. Arch Phys Med Rehabil1990; 71: 310–312.
10.
Sullivan T, Conine TA, Goodman M, Mackie T. Serial casting to prevent equinus in acute traumatic head injury. Physiother Can1988; 40: 346–350.
11.
Barnard P, Dill H, Eldredge P et al. Reduction of hypertonicity by early casting in a comatose head-injured individual. A case report. Phys Ther1984; 64: 1540–1542.
12.
Bohannon WR, Smith MB. Interrater reliability of a modified Ashworth Scale of muscle spasticity. Phys Ther1987; 67: 206–207.
13.
Teasdale G, Jennet B. Assessment of coma and impaired consciousness: a practical scale. Lancet1974; II: 81–84.
14.
van der Putten JJ, Hobart JC, Freeman JA, Thompson AJ. Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel index and the Functional Independence Measure. J Neurol Neurosurg Psychiatry1999; 66: 480–484.
15.
Mehrholz J. Die serielle Gelenkredression. In: Minkwitz K, Platz T eds. Armmotorik nach Schlaganfall. Idstein: Schulz-Kirchner Verlag, 2001: 145–152.
16.
Gajdosik RL, Bohannon RW. Clinical measurement of range of motion. Review of goniometry emphasizing reliability and validity. Phys Ther1987; 67: 1867–1872.
17.
Carlson EV, Kemp MG, Shott S. Predicting the risk of pressure ulcers in critically ill patients. Am J Crit Care1999; 8: 262–269.
18.
Breslow RA, Bergstrom N. Nutritional prediction of pressure ulcers. J Am Diet Assoc1994; 94: 1301–1304; quiz 5–6.
19.
Dauch WA. Early rehabilitation after cerebral lesions: indications, methods, results. Nervenarzt2000; 71: 259–264.
20.
Bastos PG, Sun X, Wagner DP, Wu AW, Knaus WA. Glasgow Coma Scale score in the evaluation of outcome in the intensive care unit: findings from the Acute Physiology and Chronic Health Evaluation III study. Crit Care Med1993; 21: 1459–1465.
21.
Sazbon L, Fuchs C, Costeff H. Prognosis for recovery from prolonged post-traumatic unawarness: logistic analysis. J Neurol Neurosurg Psychiatry1991; 54: 149–152.
22.
Schönle PW, Schwall D. Die KRS – eine Skala zum Monitoring der protrahierten Komaremission in der Frührehabilitation. Neurol Rehabil1995; 2: 87–96.
23.
Monitoring Pressure Ulcer Healing: An Alternative to Reverse Staging. Proceedings of the National Pressure Ulcer Advisory Panel 5th National Conference, 1997. Adv Wound Care 1997; 10: 8–107.
