[Treatment concepts of tertiary damage of the locomotor system after craniocerebral trauma].

Brain injuries are the most frequent cause of handicap in young adults. The success of rehabilitation depends mainly on the avoidance of tertiary lesions of the locomotor system. Between January 1989 and December 1991, 54 patients were treated at the neuro-rehabilitation unit of the Neurology Department of the University Hospital for severe brain injuries. On admission these patients were in different stages of recovery. All patients underwent physiotherapy adapted to their specific needs. The decision as to whether other kinds of treatment were indicated depended on the patients' problems in the recovery phase reached and on the presence or absence of tertiary lesions. In 14 patients, contractures caused by spasticity were successfully treated with plaster casts, which were changed weekly. These contractures were corrected sufficiently. In 5 other patients contractures, also caused by spasticity, were treated with regional anaesthesia administered through an implanted catheter system. In 11 patients a system for continuous intrathecal administration of Baclofen was implanted. Central side effects could be avoided while a lasting decrease of spasticity and hyper-reflexia was achieved. Persisting tertiary lesions, such as contractures, dislocations and spinal deformities, were corrected surgically.