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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici
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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Europa Medicophysica 1999 Marzo;35(1):19-25
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.