Prevention Of Contracture Research Articles

Severe Spastic Contractures and Diabetes Mellitus Independently Predict Subsequent Minimal Trauma Fractures Among Long-Term Care Residents

ObjectiveThe study aimed to examine the epidemiology of hypertonic contractures and its relationship with minimal trauma fracture (MTF), and to determine the incidence and predictors of (MTF) in long-term care residents. DesignThis was a longitudinal cohort study of prospectively collected data. Participants were followed from March 2007 to March 2016 or until death. SettingA 300-bed long-term care hospital in Hong Kong. ParticipantsAll long-term care residents who were in need of continuous medical and nursing care for their activities of daily living. MeasurementsInformation on patients' demographic data, severe contracture defined as a decrease of 50% or more of the normal passive range of joint movement of the joint, and severe limb spasticity defined by the Modified Ashworth Scale higher than grade 3, medical comorbidities, functional status, cognitive status, nutritional status including body mass index and serum albumin, past history of fractures, were evaluated as potential risk factors for subsequent MTF. ResultsThree hundred ninety-six residents [148 males, mean ± standard deviation (SD), age = 79 ± 16 years] were included for analysis. The presence of severe contracture was highly prevalent among the study population: 91% of residents had at least 1 severe contracture, and 41% of residents had severe contractures involving all 4 limbs. Moreover, there were a significant proportion of residents who had severe limb spasticity with the elbow flexors (32.4%) and knee flexors (33.9%) being the most commonly involved muscles. Twelve residents (3%) suffered from subsequent MTF over a median follow-up of 33 (SD = 30) months. Seven out of these 12 residents died during the follow-up period, with a mean survival of 17.8 months (SD = 12.6) after the fracture event. The following 2 factors were found to independently predict subsequent MTF in a multivariate Cox regression: bilateral severe spastic knee contractures (hazard ratio = 16.5, P < .0001, confidence interval 4.8–56.4) and diabetes mellitus (hazard ratio = 4.0. P = .018, confidence interval 1.3–12.7). ConclusionsSevere spasticity and contractures are common morbidities in long-term care residents, and bilateral severe spastic knee contractures and diabetes mellitus are 2 independent predictors of subsequent MTF. Spasticity management and prevention of contractures, combined with educational programs for caregivers to identify the high-risk residents and apply proper handling techniques during routine care, may be helpful in reducing the risk of MTF in long-term care residents. Further large-scale longitudinal studies are needed to confirm these findings.

Managing the stiff elbow

Significant loss of the arc of elbow motion can cause difficulties with many activities of daily living. Elbow stiffness can be due to traumatic and atraumatic causes, and the osseous and soft tissue structures of the elbow can both contribute to the contracture. This article reviews the assessment of patients with elbow stiffness and highlights the importance of prevention of contracture after surgery or trauma. Non-operative options and operative techniques are discussed, and the outcomes after each are summarized. Non-operative treatment can be successful in patients with mild contractures and with symptoms that have been present less than 6 months. In patients with more severe contracture, open or arthroscopic arthrolysis may allow patients to regain a functional range of motion. An understanding of the anatomical structures that contribute to the contracture is essential to achieve a successful surgical outcome.

Patología estenótica no traumática de la uretra posterior

IntroductionPosterior urethral stenoses and contractures are complications after treatment of benign prostatic hyperplasia (BPH), localised prostate cancer (PCa), and orthotopic neobladder formation, compromising prognosis and functional outcomes. ObjectivesTo identify factors related to aetiology, prevention and treatment of non-traumatic posterior urethral stenosis and contractures. Acquisition of evidenceReview of the published evidence related to posterior urethral stenosis and contractures after PCa treatment, BPH therapies and orthotopic neobladder formation. PubMed database search with English and Spanish papers considered. Cohort studies, case series, prospective and retrospective studies and review papers were included. Synthesis of evidencePosterior urethral stenoses and contractures are common, leading to significant morbidity. A worsening on voiding quality should rise some concerns. Careful surgical and/or radiotherapic techniques prevent their development. Endoscopic therapies are the initial approach, with complex urethroplasties often required. Subsequent urinary incontinence, the most important sequelae, may need artificial sphincters. ConclusionsNon-traumatic posterior urethral stenoses could be important complications, potentially compromising the outcomes of initial therapy. They could require complex surgeries leading to urinary incontinence.

Wide excision and healing by secondary intent for the surgical treatment of hidradenitis suppurativa: A single-center experience

This study reviewed a single center's 14-year experience with surgical treatment of chronic, severe hidradenitis suppurativa (HS) through wide excision technique and healing by secondary intention. All patients who underwent wide excision of HS between 2000 and 2014 and allowed to heal by secondary intention were included. Wound care consisted of topical antimicrobials and hydrotherapy. Physical therapy was initiated for joint contracture prevention. Patients were followed until complete wound closure. Seventeen patients underwent 23 separate surgical encounters, five with excision of multiple areas. Seventeen excisional procedures were conducted on the upper half of the body (axillary, breast) and 11 on the lower half (inguinal, perineum, perianus, and abdomen). Two patients developed HS recurrence adjacent to the surgical site (one requiring reexcision and the other treated with topical therapy), whereas two developed HS flares at distant nonsurgical sites managed medically. The mean follow-up was 1.02 years with a median of 6 months ranging from 1.2 months to 5.25 years. Complete wound healing ranged from 8 weeks to 16 months, with limited range of motion (ROM) in two patients. Attempts at removing all tissue affected by HS through wide surgical excision are the mainstay intervention for achieving complete local cure, particularly in the most severe cases of the disease. Our experience with wide excision of disease and healing by secondary intent demonstrated clinically satisfactory functional and excellent aesthetic results in multiple anatomic areas and even for large defects. This healing modality requires strict adherence to the wound healing protocol, which is often tolerated only by patients who have endured symptoms of severe HS for an extended length of time.

Botulinum Toxin A Therapy In Early Post-Stroke Spasticity: Providing A Wider Treatment Avenue

The use of Botulinum toxin type A (BoNT) to address spasticity has been established over the years, and recently considered first line treatment in chronic post stroke patients. With its promising results, BoNT is now being combined with early neurorehabilitation to treat post-stroke spasticity in order to address the various neuromuscular and biomechanical impairments, contracture prevention, dystonia, associated reactions and pain. The beneficial effects of BoNT as an adjunct to early stroke rehabilitation, in contrast to customary physical therapy alone, is the case in point of this review, so as to suggest another complementary treatment avenue in rehabilitation care.

Treatment for Patients with Charcot-Marie-Tooth Disease: Orthopaedic Aspects

The orthopedic manifestations in patients with Charcot-Marie-Tooth disease include deformity and dysfunction of the extremities and spine. Conservative treatment is the first choice. Orthosis and rehabilitation can improve function, and are important for the prevention of joint contractures. Foot problems are most commonly observed and require surgical treatment. Foot deformities include pes cavus, cavovarus, claw toes, or drop foot. Single or combined surgeries selected for soft tissues are plantar release, tendon transfer, or Achilles tendon lengthening, and those for bones are osteotomies and joint fusions. The upper limb initially demonstrates loss of power of the intrinsic hand muscles followed by symmetrical atrophy of the forearm muscle groups. The typical hand deformity is claw hand. Tendon transfer, joint fusion, soft tissue release, or nerve decompression procedures are performed for correction of hand deformities. Acetabular dysplasia in the hip joints is sometimes observed and osteotomy is selected as surgical treatment in such cases. The associated spinal deformity is scoliosis with or without kyphosis. Similar to treatment of idiopathic scoliosis, posterior spinal fusion is performed in patients with progressive spinal deformities.

湾曲型空圧アクチュエータを用いた手指伸展支援装置の開発

湾曲型空圧アクチュエータを用いた手指伸展支援装置の開発

Development of a Contracture Prevention Device using Pneumatic Actuator of Curving Type

Development of a Contracture Prevention Device using Pneumatic Actuator of Curving Type

Afferent Innervation, Muscle Spindles, and Contractures Following Neonatal Brachial Plexus Injury in a Mouse Model

We used an established mouse model of elbow flexion contracture after neonatal brachial plexus injury (NBPI) to test the hypothesis that preservation of afferent innervation protects against contractures and is associated with preservation of muscle spindles and ErbB signaling. A model of preganglionic C5 through C7 NBPI was first tested in mice with fluorescent axons using confocal imaging to confirm preserved afferent innervation of spindles despite motor end plate denervation. Preganglionic and postganglionic injuries were then created in wild-type mice. Four weeks later, we assessed total and afferent denervation of the elbow flexors by musculocutaneous nerve immunohistochemistry. Biceps muscle volume and cross-sectional area were measured by micro computed tomography. An observer who was blinded to the study protocol measured elbow flexion contractures. Biceps spindle and muscle fiber morphology and ErbB signaling pathway activity were assessed histologically and immunohistochemically. Preganglionic and postganglionic injuries caused similar total denervation and biceps muscle atrophy. However, after preganglionic injuries, afferent innervation was partially preserved and elbow flexion contractures were significantly less severe. Spindles degenerated after postganglionic injury but were preserved after preganglionic injury. ErbB signaling was inactivated in denervated spindles after postganglionic injury but ErbB signaling activity was preserved in spindles after preganglionic injury with retained afferent innervation. Preganglionic and postganglionic injuries were associated with upregulation of ErbB signaling in extrafusal muscle fibers. Contractures after NBPI are associated with muscle spindle degeneration and loss of spindle ErbB signaling activity. Preservation of afferent innervation maintained spindle development and ErbB signaling activity, and protected against contractures. Pharmacologic modulation of ErbB signaling, which is being investigated as a therapy for congestive heart failure, may be able to recapitulate the protective effects of afferent innervation in spindle development and contracture prevention. Muscle spindle preservation may also have implications in proprioception and motor learning, both of which are impaired in NBPI.

Role of stretch therapy in comprehensive physical habilitation of patients with Charcot–Marie–Tooth hereditary neuropathy

Charcot–Marie–Tooth hereditary neuropathy (Charcot–Marie–Tooth disease, CMT) is the most common form of hereditary neuropathies, accompanied by sensory disorders, progressive muscle weakness with the formation of disabling contractures of the limbs. Currently, the main treatment program is effective CMT habilitation, which can prevent the development of limb deformities and thereby improve the life quality of the patient. Stretch therapy is one of the most effective methods of prevention and treatment of contractures in patients with CMT. This article provides a brief review of the literature regarding the use of stretching as physical therapy program of CMT habilitation.

Exploring the lived experience of splinting for the prevention and correction of contractures in adults with neurological conditions

Background: This study was undertaken as part of the development of evidence based national splinting guidelines for the prevention and correction of contractures in adults with neurological dysfunction. The term splinting describes the process of applying a prolonged stretch through a range of devices such as a splint or cast. Contracture formation is complex, and are a common secondary complication of paresis andweakness following nervous system damage. As contractures can limit active function and decrease the ease of care or self-care (passive function), splints and casts can be used as part of an overall goal directed rehabilitation and management programme. However an on-going debate remains as to the apparent effectiveness of splinting as a stretch intervention. Purpose: As there is a paucity of knowledge about the experience of people with neurological conditions using splints or casts, this study aimed to explore what is was like to be the recipient of splinting. Given splinting is an area with clinical uncertainty, the need to hear the voice of service users was an essential component in the development of practice clinical guidelines for therapists. Methods: People who were current or recent users of splints or casts were purposively recruited from local support groups and charity organisations. Volunteers took part in semi-structured interviews to explore the lived experience of splinting for the correction or prevention of contractures; all interviews took place in the participant’s home. Data were audio-recorded, transcribed verbatim, and transcriptions checked against the original recordings. Data were analysed thematically. Another member of the research team independently reviewed the process of coding, first theme identification and the development of the overarching themes, supporting the rigour and transparency of the process. Results: Ten people with a neurological condition (stroke n= 6, brain injury n= 3, multiple sclerosis n= 1) took part in the study. Two participants with communication difficulties chose to include their carers, who were also consented, in their interview.The timepost-insult for the participants varied from 9months to 14 years. Wrists, hands and ankles were the most common joints for splinting. Splinting was undertaken for active and passive function. Five main themes emerged from the data: Sensemaking through goals; Splints in the real world;Looks aren’t everythingbut theydomatter;Motivation and support and the Influence ofRehabilitation Professionals. Conclusion(s): The findings from this study show the importance of the user perspectives in defining the construct of what is an effective intervention. While the experience of splinting could be described for some participants as a ‘double edged sword’, there were nonetheless benefits on a number of levels. These outcomes went beyond the oftused measure of success of range of motion. Service users described being concerned with functional outcomes, active or passive, and with wider participation in society. Implications: Given the multifaceted nature of splinting as a complex intervention,many factors and questions remain about practice and further research is required. The importance of listening to the experience of service users is evident from the insights shared as part of the guideline development process.

Passive movements for treatment and prevention of contractures—what is the evidence? A cochrane systematic review

focusing on body movements) and External focus of attention wherein instructions are given to the learner to focus externally (e.g. focusing on the task to be performed). Purpose: The purpose of this study was to investigate the influence of different types of instructions on motor skills among older adults. Methods: In this Randomized controlled trial 60 healthy elderly participants were recruited from community dwelling old age home after obtaining ethical and informed consent. Participants were randomly assigned using block randomization to one of the three groups an Internal focus group (IF), an External focus group (EF) or a control group. All the participants were unfamiliar with the task. The task was to throw vacuum ball into the center of a circular wooden board (similar to dart throwing). The tasks were divided into three phases to capture the acquisition, retention and transfer during motor learning. All the phases were performed in blocks of ten throws each. Each participant came for 2 consecutive days. On the first day, during the acquisition phase, participants threw the ball 50 times in 5 trial blocks (10 throws per block). One day after the acquisition phase, both retention and transfer phases were conducted. In the retention phase, participants threw 20 times (2 blocks of 10 throws each) from the same distance as in the acquisition phase. Several minutes later, the transfer phase will be conducted, in which participants threw 20 times (2 blocks of 10 throws each) from a further distance. Instructions for the IF group were directed at movements of the shoulder, arm, and fingers. Instructions for the EF group were directed at the target and the ball’s trajectory. Outcome measures used were Mean Radial Error [MRE] for accuracy of throwing and bivariate variable error [BE] for variability of throwing. The outcome assessor was blinded to the group allocation. Results: Repeated measures ANOVA for within and between group comparisons were done. Significant improvements in throwing accuracy and variability were seen within all the three groups. However there was significantly more improvement in throwing accuracy and reduced throwing variability in EF group compared to the IF and control group. Conclusion(s): This study shows that older adults may benefit more from external focus of instructions for motor learning compared with internal focus of instructions. Future studies are recommended to analyze the way older adults learn motor skills. Implications: External focus of instructions may be beneficial and improve motor learning among older adults.

The effects of heat, icing, and stretching on knee joint capsule in rat contracture model of spinal cord injury

Background: Contractures are highly prevalent in patients with neurological disorders. The joint capsule has important role in pathogenesis of contractures. Synovial intima length becomes shorter with the progression of contractures, and shortened synovial intima restricts range of motion. Heat, icing, and stretching are commonly used for inhibition of spasticity and treatment or prevention of contractures, however it remains unclear whether these treatments are effective for the shortening of joint capsule in neurological disorders. Purpose: Using established rat model of spinal cord injuries (SCI) of knee flexion contracture, we aimed to determine the effects of heat, icing, and stretching alone or a combination of these regimens on joint capsule. Methods: Male Wistar rats (n= 14) were used for this study. These rats were randomly divided into control group without interventions, SCI group, and following five treatment groups after SCI:

The effect of cryotherapy for the prevention of contracture

The effect of cryotherapy for the prevention of contracture

Experts Predict: What's Ahead for PA/LTC in 2015?

Experts Predict: What's Ahead for PA/LTC in 2015?

S1150203 筋リラクゼーションと関節可動域を両立する手指関節拘縮予防リハビリシステムの開発

S1150203 筋リラクゼーションと関節可動域を両立する手指関節拘縮予防リハビリシステムの開発

1P2-K01 指関節拘縮予防装置の開発

1P2-K01 指関節拘縮予防装置の開発

Orthopedic management of spina bifida

Spina bifida is associated with congenital deformities, such as kyphosis, spinal malformations, teratological hip dislocations, clubfeet, vertical talus and also with acquired deformities due to muscle imbalance and impaired biomechanics. The degree of the acquired deformities and the mobility of the patient depend on the level of the spinal lesion. Neurological symptoms are mostly asymmetric and there is an inconsistent correlation between the anatomical level of the lesion and muscle function. Deficits of sensation are usually one to two levels lower than the motor level. An exact neurological diagnosis should not be made before the second or third year of life and an early prognosis about walking ability should be avoided. The level L3 and therefore function of the quadriceps is a functional milestone after which modified independent ambulation with the use of ankle foot orthoses (AFO) and crutches is possible. The basic principle is to support verticalization and gait even when loss of ambulation is later expected. It is also important to support and maintain sitting ability for high lesions, if necessary with correction of the spinal deformity. Findings in gait analysis have shifted the focus of treatment from radiological criteria to functional improvement, thus maintenance of the flexibility of the hip is the main goal of hip surgery. Reduction of the hip often leads to stiffness and has a high redislocation rate. Clubfoot deformities should be treated early and foot arthrodesis and stiffness have to be avoided. Another focus is the prevention of joint contracture by early prophylactic treatment. The purpose of management is to maximize the functional potential of the child. Subjective well-being, absence of pain, mobility and socialization are the main goals. This does not necessarily imply ambulation; nevertheless, verticalization and associated orthotic management is one major objective of the orthopedic management of spina bifida.

Application of a vibrating device for the prevention of flexion contracture after total knee arthroplasty.

Our research team developed a new, heel support-based static and vibrating complementary treatment method for the prevention of flexion contractures often arising after total knee arthroplasty. We examined the efficiency of the method performing a randomized clinical trial with 144 patients undergoing total knee replacement. Seventy-nine patients were treated for 1 week with a generally used continuous passive motion (CPM) device complemented with our new method, which was based on the application of a static and an alternating heel support. The 65 patients in the control group were treated with only a CPM device as in usual clinical practice. The femoro-tibial angle was measured immediately following surgery, and after 1 week of treatment. At the end of the 1 week treatment, the target extension angle (0° ± 5°) was achieved by significantly more patients with the new combined method. This way the elevated heel rest and the vibrating device proved to be a good adjunct treatment along with the CPM used in routine clinical practice in the first place for the prevention of flexion contractures.

Prevention of Capsular Contracture with Photochemical Tissue Passivation

Capsular contracture is the most common complication following the insertion of breast implants. Within a decade, half of patients will develop capsular contracture, leading to significant morbidity and need for reoperation. There is no preventative treatment available and the recurrence rate remains high. Photochemical tissue passivation is a novel tissue-stabilization technique that results in collagen cross-linking. It can rapidly link collagen fibers in situ, preserving normal tissue architecture. By using this therapy to passivate the collagenous tissues of the implant pocket, the authors hope to prevent the development of pathogenic collagen bundles and subsequent capsule contracture. Six-cubic centimeter tissue expanders were placed below the panniculus carnosus muscle along the dorsum of New Zealand white rabbits. Fibrin glue was instilled into each implant pocket to induce contracture. Treated pockets received photochemical tissue passivation by coating them with a photosensitizing dye and exposing the area to a 532-nm light. After 8 weeks, capsule tissue was harvested for histologic evaluation. Implant capsule thickness is the number one prognostic factor for contracture development. The authors demonstrated a 52 percent decrease in capsule thickness in the passivated group compared with controls. Photochemical tissue passivation resulted in fewer fibrohistiocytic cells and macrophages and in reduced synovial metaplasia and smooth muscle actin deposition. Photochemical tissue passivation significantly decreased both capsule thickness and smooth muscle actin deposition. It is a promising technique for preventing capsular contracture that can be performed at the time of initial surgery without a significant increase in procedure time.