Brain injury Discussion
Brain injury may result in a variety of upper extremity problems. The most
common problems arise from a combination of spastic contracture of multiple
muscle groups, altered or lost awareness of the extremity by the patient,
and unintentional movements. The initial treatment involves splinting and
stretching to avoid fixed contractures, education to avoid unintentional
injury or pressure sores, and efforts to facilitate re-learning use of the
affected extremity. Usually, plateau of clinical recovery with optimum
therapy for a minimum of one year is allowed before considering surgery.
Indications for surgery include failure of conservative treatment to allow
functional positioning, or fixed contractures leading to potential hygiene
problems. Surgical procedures are individualized, and may involve
muscle-tendon unit lengthening, rebalancing, or arthrodesis. In some cases,
function may be improved with surgery, but this is almost completely
unpredictable, due to other consequences of the brain injury itself.
Younger patients have a better outlook than older patients in regard to
functional recovery. Problems not helped by surgery include coordination,
unintentional movements, sensation, or awareness of the affected area.
Plateau of recovery following surgery usually requires several years, and
new problems with muscle imbalance may become evident only after surgery.
Postoperative splinting for six to twelve months is commonly required to
achieve an optimum result.
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