Leung Joan, Harvey Lisa A, Moseley Anne M
Royal Rehabilitation Centre Sydney ; Sydney Medical School.
Royal Rehabilitation Centre Sydney ; Rehabilitation Studies Unit, Sydney Medical School/Northern, University of Sydney.
Physiother Can. 2013 Summer;65(3):223-8. doi: 10.3138/ptc.2012-29.
While contemporary management of contractures (a common secondary problem of acquired brain injury that can be difficult to treat) includes passive stretch, recent evidence indicates that this intervention may not be effective. This may be because clinical trials have not provided a sufficient dose or have not combined passive stretch with other treatments. The purpose of this case report is to describe a programme of intensive passive stretch combined with motor training administered over a 1.5-year period to treat severe knee contractures.
Five months after traumatic brain injury, an adolescent client with severe contractures in multiple joints underwent an intensive stretch programme for his knee contractures, including serial casting and splinting, which was administered for 10 months in conjunction with a motor training programme administered for 1.5 years.
The client regained full extension range in his knees and progressed from being totally dependent to walking short distances with assistance; these effects were maintained at follow-up 5.5 years after injury.
The use of a high dose of passive stretch in conjunction with motor training may be an option to consider for correcting severe contractures following acquired brain injury.
挛缩是获得性脑损伤常见的继发性问题，治疗难度较大，虽然当代对挛缩的处理包括被动牵伸，但最近的证据表明这种干预可能无效。这可能是因为临床试验未提供足够的剂量，或者未将被动牵伸与其他治疗方法相结合。本病例报告的目的是描述一个为期1.5年的强化被动牵伸与运动训练相结合的方案，用于治疗严重的膝关节挛缩。
一名青少年在创伤性脑损伤5个月后，因多关节严重挛缩接受了针对膝关节挛缩的强化牵伸方案，包括序贯石膏固定和夹板固定，为期10个月，并结合了为期1.5年的运动训练方案。
该患者膝关节恢复了完全伸展范围，从完全依赖状态进展到在辅助下能短距离行走；这些效果在受伤5.5年后的随访中得以维持。
大剂量被动牵伸与运动训练相结合可能是治疗获得性脑损伤后严重挛缩可考虑的一种选择。
