Knee Flexion contracture with spasticity

[cyril_tabz]

hi! is there any non-operative way to correct a knee flexion contracture of about 30-45 degs secondary to spasticity. i have a patient who is like this. ty!

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[aladin]

hi out there
there are some possibilities to deal with your problem, but, first of all, you have to identify some goals on activity or paticipation level - if there are goals you have to know that there will be much work for you and your patient! (costs and time!)
1st: you can do a serial casting with splints of plaster or much more comfortable with scotchcast - (change splints weekly)
2nd: there is a chance to use botox to decrease the amount of spasticity, in this case you need a patient, who is able to do exercises for some hours a day, because there is a need to lengthen the "spastic" muscles much more than one time a day
3 rd: a combination of both, with the idea of changing the splints weekly

in our experience you need about 4- 5 weeks to gain a rather "normal" muscle length -
more details e.g. in : sue edwards; neurological rehabilitation
hope that helps
detl

[perfphysio]

I have had good success with using reciprocal inhibition couple with muscle stimulation and biofeedback. It does however depend on the cognitive state of the client. You may also try unweighting during the rehab to decrease gravities affect on the spasticity (or is it an increase in tone). If gravity is a factor then you may have to instruct the client to stay off walking for 8-10 weeks, so the "brain gets the message"? Would anyone else take this type of approach?

[Mich]

You need to work out whether the contracture is due to musle shortening or due to spasticity. If spasticity is the issue then Botulinum toxin would help, followed by serial casting for a couple of weeks, then scotchwrap splints, stretches and eccentric and concentric work. If the muscle has adaptively shortened then Botulinum toxin probably won't helpand serial casting may be the way to go, followed by scotchwrap etc. Keep an eye on gastroc length as well. .....oh .. Make sure there is no HTO before you immobilise the joint though!