Spasticity Management in Persons with Disorders of Consciousness.

INTRODUCTION

Spasticity is one of the most frequent neurological impairments affecting persons with disorders of consciousness (DoC). If left untreated, it can mask signs of consciousness by inhibiting one's ability to interact with the environment. The lack of information about spasticity specific to patients with DoC may result in insufficient or even inappropriate treatment.

OBJECTIVE

To report spasticity characteristics and management in a large dedicated DoC rehabilitation program.

DESIGN

Retrospective chart review.

SETTING

An inpatient rehabilitation hospital.

PARTICIPANTS

Patients admitted to the DoC rehabilitation program from 1 January 2014 to 31 October 2018.

MAIN OUTCOME MEASUREMENTS: Spasticity characteristics; impact of interventions on spasticity as well as other clinical measures.

RESULTS

A total of 146 patients were included, of whom 95.2% were affected by spasticity; 52.7% had spasticity affecting all four limbs. The most commonly affected muscle groups were shoulder internal rotators (72.6%) in the upper extremity and ankle plantar flexors (59.8%) in the lower extremity. The more commonly affected muscle groups were also more spastic (R = 0.993 and 0.989 in the upper and lower extremity, respectively; P < .01). Atypical posture patterns were also commonly observed, making positioning difficult. Chemoneurolytic injections (botulinum toxin and/or phenol) were performed in over 69.9% patients, and 26.7% had intrathecal baclofen (ITB) pump placement. All patients received individualized physical modalities and therapies. With focal managements, systemic spasmolytic medications, including enteral baclofen, were reduced by at least 50.0%, which appeared to be associated with improvements in the level of consciousness.

CONCLUSIONS

Almost all DoC patients were affected by spasticity, often to a moderate or severe degree. Extensive use of focal spasticity interventions allowed for weaning of systemic spasmolytic medications, which seemed to result in improvements in the level of consciousness.