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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Europa Medicophysica 1999 March;35(1):19-25


language: English

Muscular-tendinous contractures in mentally retarded subjects associated with neuromotor impairment. A prospective clinical study of distribution, severity and evolution

Bianchi C., Rossi S., Dal Brun A. M., Brambilla A.

Rehabilitation Department, Sacra Famiglia Institute, Onlus Foundation, Cesano Boscone (Milano), Italy


BACKGROUND: Subjects affect­ed by ­severe infan­tile cere­bral pal­sy (­severe men­tal retar­da­tion and ­motor def­i­cits) ­present ortho­paed­ic defor­mities in all ­four ­limbs. These def­or­mat­ies are sec­on­dary to mus­cu­lar-ten­di­nous (MT) con­trac­tures. Predicting the ­course and out­come and defin­ing the rel­a­tive ther­a­peut­ic indi­ca­tions of MT con­trac­tures ­remain con­tro­ver­sial.
METHODS: In a ­study pop­u­la­tion of 50 insti­tu­tion­al­ised men­tal­ly retard­ed sub­jects ­with a neu­ro­log­i­cal pic­ture of spas­tic he­mi­ple­gia, diple­gia or tet­ra­ple­gia (TPL), we ­sought to doc­u­ment the dis­tri­bu­tion , sever­ity and evo­lu­tion of the MT con­trac­tures in the ­four ­limbs ­over a 3 to 4-­year peri­od. There ­were 7 sub­jects ­with hae­mi­ple­gia, 11 ­with diple­gia, and 32 ­with TLP. The 32 sub­jects ­with TLP ­were divid­ed ­into two sub­groups. TLP ­group 1 com­prised 13 sub­jects ­with nei­ther ­trunk con­trol nor sig­nif­i­cant motric­ity in the ­four ­limbs. TLP ­group 2 con­sist­ed of 19 sub­jects ­with min­i­mal pos­tu­ral and ­motor abil­ities. MT con­trac­tures ­were ­assessed and inter­pret­ed on the ­basis of mus­cle ­tone (as meas­ured by the Ashworth Scale) and of the ­acquired defor­mities ­with sec­on­dary lim­i­ta­tions in ­range of ­motion (ROM).
RESULTS: ROM lim­i­ta­tions in the ­joints exam­ined ­ranged ­from 5 to 89% of the max­i­mal phys­io­log­i­cal ROM. There ­were no cor­re­la­tions ­between ROM lim­i­ta­tions and spas­tic­ity of the con­tract­ed mus­cles (p<0.05). There was a cor­re­la­tion ­between ROM lim­i­ta­tion of the ­knee ­joint and the diag­nos­tic ­group. The ­most ­severe MT con­trac­tures, ­with a ­mean ROM lim­i­ta­tion of 37°, ­were ­observed in TLP ­group 1. TLP ­group 2 ­showed a ­mean ROM lim­i­ta­tion of 35.5°. Lower ­mean val­ues ­were ­observed in the sub­jects ­with diple­gia (7.2°) and he­mi­ple­gia (1.4°).
CONCLUSIONS: The sever­ity and dis­tri­bu­tion of ROM lim­i­ta­tions var­ied with­in the ­same sub­ject and ­among sub­jects of the ­same or dif­fer­ent diag­nos­tic ­groups. This var­i­abil­ity ­appeared to be ­caused ­more by the pat­terns of resid­u­al vol­un­tary move­ment ­than by mus­cle ­tone, ­which was fair­ly homo­ge­ne­ous with­in and ­between sub­jects. During the 3-4 ­year peri­od of obser­va­tion, MT con­trac­tures wors­ened in ­only 1 of the 50 sub­jects. This indi­cates ­that ROM lim­i­ta­tions ­initiate ­before age 15, and ­that the ­joint defor­mities ­remain sta­tion­ary on com­ple­tion of ­growth. Thus, ­this ­study pro­vides a prog­nos­tic ­basis for assess­ing the sever­ity and dis­tri­bu­tion of MT con­trac­tures in sub­jects ­with men­tal retar­da­tion and neu­ro­mo­tor def­i­cits. It ­would ­appear ­that ­there are few indi­ca­tions for kine­sis ther­a­py to coun­ter­act the ­onset of MT con­trac­tures.

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