Severe loss of movement is often the result of brain injury or other neurological disorders such as stroke, polio and cerebral palsy. This loss of movement can make even the most ordinary of daily activities impossible to accomplish. People affected by spasticity, contracture and loss of mobility may not be able to walk and may live without being able to wash, dress or feed themselves. Often confined to bed or to a wheelchair, these people need extensive care from family members and other caregivers.

Weeks to months after a brain injury, patients may develop or begin to exhibit a variety of complications including motor control problems, muscle overactivity, or musculoskeletal deformities. When musculoskeletal complications are present, patients lose the ability to recruit and relax muscles on command. Motor control suffers, and patients may exhibit a wide range of symptoms ranging from mild muscle stiffness to paresis, spasticity or disabling contracture.

Fortunately, the consequences of brain or neurological injury at the musculoskeletal level can be addressed even years after the injury occurred or the complications noted. Intervening at any time post-ABI can be key to relieving pain, reducing stiffness, improving function, avoiding further complications and improving the patient’s quality of life.

In general, the characteristics observed with abnormal muscle activity are those of an upper motor neuron (UMN) syndrome, a collective term for motor behaviors that may occur in ABI patients. Clinical evaluation tools such as the Modified Ashworth and Tardieu Scales, Gross Motor Function Measure (GMFM), and Gross Motor Performance Measure (GMPM) may be used to quantify the degree of spasticity, tone or functional ability.

The impairment may result from negative signs including paralysis or immobilization, or delayed positive signs including clonus, flexor and extensor spasms or spastic dystonia with resulting limitation in range of motion and the potential development of disabling contracture.

Dr. Esquenazi, in the Journal of Head Trauma Rehabilitation, notes the evaluation of musculoskeletal complications is focused on three issues:

• Identifying the clinical pattern of motor dysfunction and its source
• Identifying the patient’s ability to control muscles involved in the clinical pattern
• Distinguishing the role of muscle stiffness and contracture as it relates to the functional problem