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Intracranial haemorrhage
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
FALSE – Decerebrate posturing is arms extended and decorticate is arms flexed. This abnormal posturing is an ominous sign and requires immediate medical attention since it may be a sign that coning of the brain is occurring or about to take place.
Caring for an individual
Published in Ross Balchin, Rudi Coetzer, Christian Salas, Jan Webster, Addressing Brain Injury in Under-Resourced Settings, 2017
Ross Balchin, Rudi Coetzer, Christian Salas, Jan Webster
The brain is protected in a bony case called the skull. However, the skull cannot expand and if a brain injury causes the brain to swell, the brain is pushed down through a narrow circular opening at the base of the skull known as the foramen magnum. This is a form of brain herniation and is often accompanied by abnormal posturing. Here, the brainstem, which controls breathing and heart rate, is compressed and can stop working, and death can result.
Neuropharmacologic considerations in the treatment of vegetative state and minimally conscious state following brain injury
Published in Mark J. Ashley, David A. Hovda, Traumatic Brain Injury, 2017
The assessment of arousal and cognitive content is but a part of a complete physical and neurologic examination. Cranial nerves should be evaluated because their function is a reflection of brain stem integrity. Muscle tone and abnormal posturing should be assessed. Severe spasticity or rigidity may preclude visible limb movement. In patients with disorders of consciousness, strength is inferred from observed spontaneous movement because formal manual muscle testing is not possible. Be aware of contractures that may limit movement. The patient’s response to noxious stimulation should be assessed, and reflexes (normal and pathologic) should be noted.
Factors associated with joint contractures in adults: a systematic review with narrative synthesis
Published in Disability and Rehabilitation, 2023
Hina Tariq, Kathryn Collins, Desiree Tait, Joel Dunn, Shafaq Altaf, Sam Porter
Spasticity was identified as a potential factor for contractures in six out of nine studies that evaluated the relationship between the two variables. This is supported by the underlying theory that abnormal muscle activity associated with spasticity could lead to abnormal posturing resulting in muscle and soft-tissue shortening and, consequently, forming a contracture [72]. However, the evidence provided by these studies is questionable because the methods utilised to measure or evaluate the presence of spasticity were not consistent. There is sufficient evidence that while conventional clinical scales are easy to administer, they also lack clinical sensitivity and have limited validity and reliability to document the abnormal muscle activity associated with spasticity [73,74]. On the contrary, neurophysiological measurements provide a direct measure of muscle activity to quantify spasticity according to the existing definition [74]. In this review, the only study that utilised a neurophysiological measure to identify the presence of spasticity and found a significant association with contractures lacked statistical power (n≤ 30) [32]. In addition, the study failed to consider the evaluation of confounders alongside spasticity and weakness, such as upper limb function, which could be the primary factor for the development of contractures [60].
Experienced consequences of spasticity and effects of botulinum toxin injections: a qualitative study amongst patients with disabling spasticity after stroke
Published in Disability and Rehabilitation, 2021
Hans C. J. W. Kerstens, Ton Satink, Maarten J. Nijkrake, Bert J. M. De Swart, Maria W. G. Nijhuis-van der Sanden, Philip J. Van der Wees, Alexander C. H. Geurts
Participants characterised spasticity in terms of increased tension in their limbs, stiffness, trembling and muscle cramping, which often resulted in the clawing of fingers and toes. These physical impairments caused problems in activities of daily life (e.g. dressing and walking). The execution of such activities was negatively influenced by stress in terms of time pressure or by being watched by others: “When I give presentations at work, I hold my arm, because the attention from the audience makes the cramps worse, causing my arm to rise” (P9). All of the patients reported experiencing abnormal posturing of the arms and legs. They expressed that loss of joint mobility in the affected ankle prevented them from taking normal steps with the non-affected leg. Many participants reported a flexed posture of the arm, wrist and fingers, which caused deformation of the limb. In addition to an unpleasant sensation, the abnormal limb posture limited the functional use of the hand: “I like to take flowers when I visit people. I can’t do that anymore. The position of my fingers prevents me from holding them”(P8). Many participants reported that muscle length decreased over time, thereby reinforcing the abnormal limb posture and requiring further adaptation of movement patterns.
The positive and the negative impacts of spasticity in patients with long-term neurological conditions: an observational study
Published in Disability and Rehabilitation, 2021
Sandy Ayoub, Jared G. Smith, Isabel Cary, Catherine Dalton, Aimee Pinto, Claire Ward, Alessia Saverino
Interestingly, Social Embarrassment (“Caused strangers to stare at me,” “Made me fearful that I would cause myself physical injury,” “Caused strangers to notice me” and “Caused others to avoid touching me”) significantly correlated with severity of spasticity of the right arm. A possible explanation is that patients presenting with an abnormal posturing of the upper limb due to spasticity may perceive this as socially embarrassing. Botulinum Toxin in the upper limb for cosmetic reasons can improve the perception of body image and its impacts on participation is used in clinical practice [25]. It is also possible that impaired function affecting the dominant limb (more commonly the right) could be more easily noted as the impact on functional skills is more pronounced.