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Europa Medicophysica 1999 March;35(1):19-25

Copyright © 1999 EDIZIONI MINERVA MEDICA

lingua: Inglese

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.