Traumatic Brain Injuries
Ivanhoe, Cindy B., The Exceptional Parent
Severe injury or trauma to the brain (known as traumatic brain injury -- TBI) can often cause spasticity. Over time and if left untreated, spasticity. Over cause deformities such as contractures and interfere with the activities of daily living (ADLs).
In assessing a person with TBI, the team consideers the severity of the injury, the length of time since it occurred, how recuperation has progressed, and any changes that might affect functioning. Injuries are rated mild, moderate, or severe by the team. The more severe the injury, the longer the time required for improvement. The type and timing of treatment also affect the outcome.
To date, no oral medication has proved effective for treating spasticity due to TBI. Levels of cognitive functioning (memory, attention and concentration) can be adversely affected by oral medications, sedation is often induced and spasticity remains undiminished regardless of dosage.
One oral medication, tizanadine (Zanaflex[R], was recently released for the treatment of certain types of spasticity; however, clinical experience with Zanaflex in children and adults with TBI is limited.
Casting and stretching
Casting techniques for positioning and stretching can improve an individual's movement patterns and skills. For example, a spastic hand can be casted to facilitate relaxation of the fingers. It is important to note, however, that casting is not well-tolerated in individuals with severe spasticity.
Serial casting of limbs can be essential for individuals with TBI-induced spasticity. During the serial casting process, a joint is stretched and then casted in the most useful position. The cast is removed within a day or two after further stretch is achieved. This process is repeated until maximum range of motion occurs.
Another form of casting, called inhibitory casting, applies constant pressure along particular areas of the sole of the foot which can further decrease tone and improve function.
Injections alone or with casting can decrease tone. Unlike oral medications, injections can specifically target the muscles responsible for the body position that needs to be corrected. The most commonly injected medications are phenol and botulinum toxin (Botox[R]).
Phenol is used when nerve (or motor) point blocks are performed. Motor point blocks involve a series of injections of very small amounts of phenol into target muscles. …