Diagnosis and Treatment Model of the COVID-19 Rehabilitation Unit
Wenguang Xia, Xiaolin Huang in Rehabilitation from COVID-19, 2021
Joint contracture refers to the limitation of the active and passive range of joint motion due to the inactive state of patient’s joints, muscles, and soft tissues. Joint contractures can be caused by pain, poor posture for a long time, fear of increased oxygen consumption by activities, and psychological factors. The pathological basis of contracture caused by any reason is the abnormality of collagen tissue. Long-term immobilization can cause inflammatory changes in the joints, resulting in intra-articular adhesions, proliferation, and bursa’s fibrosis. Simultaneously, joint fixation can lead to changes in the synovium and proliferation and shortening of collagen in the joints, which can cause joint contractures. The essence of contracture is connective tissue abnormality, including abnormality of collagen and matrix, and the two influence each other. Active and passive exercises are the simplest means to deal with contractures, which have preventive and therapeutic effects.
The Problems
John Greene, Ian Bone in Understanding Neurology a problem-orientated approach, 2007
It is important to watch someone walking. This may show the scissoring gait of spasticity, reveal a foot drop gait, or the slow initiation and turning of a movement disorder such as Parkinson’s disease. If specific tasks are described as difficult then the patient should be asked to perform them if possible, and any difficulty observed. It is also critical to examine for muscle wasting; the upper limbs should be first examined from behind the shoulders so that the periscapular muscles can be seen. The arms, forearms, and hands are then looked at. These muscles are usually larger in the dominant arm. The hands should be held supinated to look at the forearm flexor muscles. The first dorsal interosseus and thenar eminence should be examined with care; wasting is easily missed. The limbs should be examined for any evidence of joint contracture.
Clinical Assessment and Management of Spasticity and Contractures in Traumatic Brain Injury
Anand D. Pandyan, Hermie J. Hermens, Bernard A. Conway in Neurological Rehabilitation, 2018
Contractures are more likely to develop in patients who do not recover motor function. Malhotra et al. (2011) examined the time course of development of spasticity and contractures at the wrist after stroke in a longitudinal observational study. Spasticity was measured by quantifying muscle activity during passively imposed stretches at two velocities. Contractures were measured by quantifying passive range of movement and stiffness. Upper limb functional movement was assessed using the action research time test. Thirty patients who had no arm function within the first 6 weeks of stroke were followed for 36 weeks. Twenty-eight (92%) patients developed spasticity throughout the study period. Patients who recovered arm function (n = 5) showed signs of spasticity at all assessment points but did not develop contractures. Patients who did not recover useful arm function (n = 25) had signs of spasticity and abnormalities associated with contracture formation at all time points tested. The findings from this study highlight the importance of early interventions to prevent development of contracture. Physical modalities such as stretching, casting, and splinting are beneficial for this purpose. Electrical stimulation has shown some evidence in reducing the rate of contracture formation (Malhotra et al. 2013).
Assessment of spasticity: an overview of systematic reviews
Published in Physical Therapy Reviews, 2022
Saleh M. Aloraini, Emtenan Y. Alyosuf, Lamya I. Aloraini, Mishal M. Aldaihan
A variety of clinical manifestations may appear following an UMNL, These clinical manifestations are generally classified as positive or negative features [1]. Positive features are those not normally present prior to the UMNL, and the negative features are those that are lost following the UMNL [1]. Spasticity is one of the positive features of an UMNL, and should not be confused with other similar positive features such as: spastic dystonia, clonus or contractures [1]. A contracture is a pathological condition manifested by restriction or loss of full active and passive range of motion of the limb; due to mechanical alteration of joint, muscle or surrounding soft tissues [8, 9]. Despite this significant difference between spasticity and contractures, some measures of spasticity are still unable to discriminate between these two clinical phenomena [10, 11].
Factors associated with upper extremity contractures after cervical spinal cord injury: A pilot study
Published in The Journal of Spinal Cord Medicine, 2018
Dustin Hardwick, Anne Bryden, Gina Kubec, Kevin Kilgore
Spinal cord injury (SCI) is the second leading cause of paralysis, with approximately 1.3 million people living with paralysis due to SCI. Joint contractures, reported to affect as much as 85% of persons with SCI, is a common complication in SCI.1–3 Joint contractures are an insidious co-morbidity of spinal cord injury that can lead to pain, deformity, loss of function, chronic pain, skin breakdown, sleep disturbance, increased caregiver needs, difficulty with bladder and bowel management, and ultimately contribute to decreased levels of independence and an overall lower quality of life.4,5 Furthermore, joint contractures may exclude individuals for eligibility or limit potential functional gains from upper extremity reconstruction surgery such as tendon transfers.6 Wrist and hand contractures may exclude individuals from tendon transfer surgeries aimed at restoring pinch and grasp. Elbow and shoulder joint contractures limit reach and workspace for the hand limiting function even if grasp is restored through tendon transfer and may exclude individuals from eligibility for tendon transfers to restore elbow extension.7–9
Fitting transtibial and transfemoral prostheses in persons with a severe flexion contracture: problems and solutions – a systematic review
Published in Disability and Rehabilitation, 2022
Jutamanee Poonsiri, Pieter U. Dijkstra, Jan H. B. Geertzen
Therefore, it is essential to consider exercises, stretching, splinting, or other contracture treatments to relieve the knee flexion contracture in addition to the prosthesis use. In the reports about a bent knee pylon or kneeling bearer, the knee was held in 90° flexion during walking, but there was still a reduction in flexion contracture [37]. Although they are easy to fabricate and cost-effective [37], in some cases the knee flexion contracture increased after the use of a bent knee pylon [37,38]. Hence, no matter what type of prosthetic device is fitted, the receivers should be trained in stretching and exercising their limbs. For example, adaptive training sessions were given to a person with a TT amputation with a knee flexion contracture [43]. After four months of training, improvements were found in the knee’s range of motion, the level of functioning, and the person’s quality of life [43].
Related Knowledge Centers
- Fibrosis
- Hypertonia
- Spastic Diplegia
- Joint
- Spasticity
- Pathology
- Skeletal Muscle
- Glycogen Storage Disease Type V
- Bethlem Myopathy
- Physical Therapy