Physiotherapy management of contractures after acquired brain injury

Abstract

The first part of the thesis investigates treatments for contracture management. The hypothesis is that passive stretch is effective when a high intensity is used and when it is combined with treatments that target the underlying causes of contractures. To support this hypothesis, a case report was presented which described a resolution of severe knee contractures following an intensive program of passive stretch administered in conjunction with motor control training. Two randomised controlled trials were conducted to assess if electrical stimulation was an effective adjunct treatment to address spasticity and muscle weakness, factors believed to contribute to contractures. The findings of both studies demonstrate that electrical stimulation administered in conjunction with passive stretch is not more useful than passive stretch alone for people with severe motor and cognitive impairments. This result highlights a need to consider other treatment options in future research. The second part of the thesis investigates the impact of ankle contractures on the knee joint. An observational study establishes the link between ankle contractures and increased knee extension, and identifies the two gait patterns that are associated with simulated ankle contractures. This information contributes to the understanding of gait deviations that are secondary to ankle contractures.