Abstract
Objectives: In this retrospective study, we investigated how spasticity developed in patients diagnosed with a prolonged DOC over an almost two-year observation period (21 months), and how it related to the patients’ age, gender, time since injury, etiology, level of consciousness, and anti-spastic medications. Methods: In total, 19 patients with a severe brain injury and prolonged DOC admitted to a long-term care facility were included in this study (14 male, age: 45.8 ± 15.3 years, 10 traumatic brain injury, 1.01 ± 0.99 years after brain injury, 11 minimally conscious state vs. 8 vegetative state). Each patient was assessed at admission and then quarterly, totaling eight assessments over 21 months. Spasticity was measured with the Modified Ashworth Scale (MAS) for both upper and lower limbs. The Western Neuro Sensory Stimulation Profile (WNSSP) was administered to assess the level of consciousness. Any other medical and demographic information of interest was obtained through medical records. Linear mixed models were used to assess each variable’s impact on the change of spasticity over time. Results: Significant differences were observed in the evolution of spasticity in patients based on their etiology for the upper limbs [F (7, 107.29) = 2.226; p = 0.038], and on their level of consciousness for the lower limbs [F (7, 107.07) = 3.196; p = 0.004]. Conclusion: Our preliminary results suggest that spasticity evolves differently according to the type of brain lesion and the level of consciousness. Spasticity in DOCs might therefore be mediated by different mechanisms and might have to be treated differently among patients. Future longitudinal studies should be performed prospectively in a bigger cohort and with data collection beginning earlier after brain injury to confirm our results and better understand the evolution of spasticity in this population.
Highlights
Spasticity is best defined as a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks, resulting from a hyperexcitability of the stretch reflex which results from abnormal intra-spinal processing of primary afferent inputs [1]
A better understanding of the mechanisms of spasticity would most likely help clinicians in finding treatments that are more efficient to manage spasticity. The aim of this retrospective study is to investigate how spasticity develops in patients diagnosed with a prolonged disorder of consciousness (DOC) over an almost two-year observation period (21 months), and what medical and demographic factors might affect its development
The inclusion criteria were as follows: (1) diagnosis of a DOC such as a vegetative state or a minimally conscious state based on the Western Neuro Sensory Stimulation Profile [12], (2) a prolonged DOC [13], (3) age 18 years or over, and (4) no documented neurological disorders prior the severe acquired brain injury
Summary
Spasticity is best defined as a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks, resulting from a hyperexcitability of the stretch reflex which results from abnormal intra-spinal processing of primary afferent inputs [1]. Spasticity frequently develops in patients with severe brain injury who are diagnosed with a prolonged disorder of consciousness (DOC). The prevalence of spasticity in DOC patients ranged from 59% to 89% in a recent review of 18 published articles [2]. Despite its broad usage in this population, a review of trials showed that there is limited evidence of effective oral baclofen treatment of spasticity in individuals with a brain injury [9]. Despite the high prevalence and impact of this impairment in this population, current treatment options are very limited and inefficacious at treating spasticity in DOC patients. The aim of this retrospective study is to investigate how spasticity develops in patients diagnosed with a prolonged DOC over an almost two-year observation period (21 months), and what medical and demographic factors might affect its development
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
