The impact of spasticity and contractures on dependency and outcomes from rehabilitation

Background: Acquired brain injury (ABI) can result in severe physical impairment causing difficulty with moving which, if not actively managed, can lead to contracture and deformity. Delayed access to rehabilitation may result in more contracture, with potential to increase duration of rehabilitatio...

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Bibliographic Details
Published in:Journal of the International Society of Physical and Rehabilitation Medicine 2022-07, Vol.5 (3), p.97-104
Main Authors: Stephen Ashford, Barbara Singer, Hilary Rose, Lynne Turner-Stokes
Format: Article
Language:English
Subjects:
acquired brain injury
contracture
cost
functional gains
spasticity
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Summary:Background: Acquired brain injury (ABI) can result in severe physical impairment causing difficulty with moving which, if not actively managed, can lead to contracture and deformity. Delayed access to rehabilitation may result in more contracture, with potential to increase duration of rehabilitation, cost and therapy time required. Objective: Describe the amount of therapy input for patients undergoing specialist in-patient rehabilitation following ABI, the differences in the type of therapy received by people with and without contracture and/or spasticity, and the impacts on functional outcomes including care needs and cost of care. Materials and Methods: A cohort analysis of prospectively collected data from 426 patients with ABI in a UK tertiary inpatient rehabilitation program. The Neurological impairment Scale (NIS) was used to identify the presence of spasticity or contracture. The Northwick Park Therapy Dependency Assessment (NPTDA) was used to calculate the therapy hours and type of treatment provided to people with and without spasticity and/or contracture. Outcomes (change in function and independence) were compared including the UK Functional Assessment Measure (UK FIM+FAM). Results: The Male/Female ratio was 63:37% with a mean age: 44.0(SD 13) years and a mean length of stay in specialist inpatient rehabilitation: 103 (SD 49) days. Aetiology: Stroke (63%), Trauma (20%); Hypoxia (7%): Other (10%). Patients with contractures were significantly more dependent than those without, both on admission and discharge. They stayed on average 31 days longer (95%CI 21.1, 40.5) (P=0.001) with an additional mean episode cost of £25,588 (95%CI £18.085, 34,043) (P
ISSN:2589-9457
2589-9457
DOI:10.4103/ijprm.JISPRM-000166