Brain injury Discussion

Brain injury may result in a variety of upper extremity problems. The most common problems arise from a combination of spastic contracture of multiple muscle groups, altered or lost awareness of the extremity by the patient, and unintentional movements. The initial treatment involves splinting and stretching to avoid fixed contractures, education to avoid unintentional injury or pressure sores, and efforts to facilitate re-learning use of the affected extremity. Usually, plateau of clinical recovery with optimum therapy for a minimum of one year is allowed before considering surgery. Indications for surgery include failure of conservative treatment to allow functional positioning, or fixed contractures leading to potential hygiene problems. Surgical procedures are individualized, and may involve muscle-tendon unit lengthening, rebalancing, or arthrodesis. In some cases, function may be improved with surgery, but this is almost completely unpredictable, due to other consequences of the brain injury itself. Younger patients have a better outlook than older patients in regard to functional recovery. Problems not helped by surgery include coordination, unintentional movements, sensation, or awareness of the affected area. Plateau of recovery following surgery usually requires several years, and new problems with muscle imbalance may become evident only after surgery. Postoperative splinting for six to twelve months is commonly required to achieve an optimum result.

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