Ankle contracture in people with acquired brain injury (ABI), intervention, and outcome following inpatient neurorehabilitation categorized by severity

Abstract

Background: Acquired brain injury frequently causes difficulty with moving and walking, which if not actively managed, can lead to secondary contracture and deformity. Intervention to manage ankle contracture may include conservative methods (eg, serial casting, standing) or more invasive methods (eg, Achilles-tendon lengthening surgery). Methods: Data were extracted from the UK Rehabilitation Outcomes Collaborative database for all admissions from 2015 to 2018 with a diagnosis of acquired brain injury from 1 tertiary rehabilitation center. Clinical records were reviewed to identify the 101/357 (28%) with ankle contracture. Categorization according to the degree of contracture was performed, as mild (>plantigrade), moderate (<plantigrade to −20°), or severe (>−21°) based on ankle range of movement. Data were analyzed to determine the change in the range of movement, function, outcome, and categorize intervention type. Primary measures: range of movement, UK Functional Independence Measure+Functional Assessment Measure, and Functional Ambulatory Category. Results: In the cohort, significant improvement in range of movement occurred following treatment (54.17; P=0.000). Treatment interventions applied included stretch interventions such as serial casting. Standing programmes, orthotics, and task practice were the most frequently applied interventions. Achilles-tendon lengthening surgery was used in a small number of cases (n=13). A statistically significant change in the range of movement was not seen in the mild category (1.05; P=0.29) but was in the moderate (5.436; P=0.001) and severe categories (10.4; P=0.001). Improvement in locomotion was noted in all 3 groups (6.10; P=0.001) but was most pronounced in the moderate and severe groups. Discussion: Improved functional outcome was observed in mild contracture with less change in joint range. In those categorized as moderate and severe, greater improvement in joint range of movement as well as function were identified following intervention.