SPASTICITY IN PATIENTS WITH SEVERE ACQUIRED BRAIN INJURY: AN INPAIRMENT THAT IS POORLY UNDERSTOOD AND POORLY MEASURED

Objective: to investigate any parametric and non-parametric correlations that might influence the development of spasticity in 27 patients affected by SBI in order to optimize their clinical and rehabilitative approach. Design: an observational and investigational study. Patients: 27 patients (14 males, 13 females; mean age 65 ± 15yy), affected by severe acquired brain injury and recovered in our Neurological Rehabilitation Section from February to October 2009. Methods: In accordance with our clinical study inclusion criteria (GCS < or = 8, LCF < or = 3, DRS < or = 22), patients were divided in 4 observational groups (post-stroke group, post-haemorrhagic group, post-anoxic group, post-traumatic group) and evaluated under an epidemiological, clinical and functional point of view. All patients had been undergoing same physiotherapy during the recovery and observational period, 6 days a week, in 2hour session, consisting in passive limb kinesis, neurodynamic limb exercises and postural control exercises. Results: 85% of patients recruited developed an upper and/or lower limb spasticity, never demonstrated in other clinical evidences. We observed that a) post-haemorrhagic group showed a higher incidence of limb spasticity b) spasticity will develop earlier in poststroke and traumatic patients c) spasticity severity is stronger in post-anoxic and traumatic brain injury. These parametric data were not statistically significant (p > 0.05). All patients received drug and physiotherapic treatment but only 30% of them will not develop limb spasticity. In line with the non- parametric statistical analysis, no correlation between the development of limb spasticity and nutritional and co-morbidity patients status was observed. Conclusions: The main finding of our study is that post-anoxic and TBI lesions have severe clinical picture with more bilateral and severe limb spasticity. We also observed that post-haemorrhagic patients develop rapidly spasticity mainly in the limbs and mainly if the lesion involves the subcortical nuclei, but these findings are not in agreement with the recent literature. Treating limb spasticity we noted that rehabilitative approach was more successful in patients with haemorrhagic lesion than in patients affected by post-anoxic state or TBI. In spite of the described conclusions, the definition of spasticity is not well known and investigated and represents an important step in order to optimize the clinical and rehabilitative approach of patients with SBI and affected by spasticity and pain related syndrome.