Article

PURPOSE: To analyse physiotherapy interventions and evaluate their effectiveness
in the prevention and management of contracture with patients admitted in either
vegetative or minimally conscious state in a UK Inpatient Regional Acquired Brain
Injury Rehabilitation Service. METHOD: Retrospective audit of dependency levels
and physiotherapy interventions in ten vegetative or minimally conscious state
patients admitted over a 3-year period (2006-2009). Admission and discharge
patient dependency status, Wessex Head Injury Matrix data and passive range of
movement measurements on admission and discharge from physiotherapy were
recorded. RESULTS: All patients presented with hypertonicity including
contractures and all initially received a manual stretching/passive movement
programme. Casting/splinting was employed in 8 cases and 7 received botulinum
toxin injections. Standing regimes were initiated for 8 patients. No patient
emerged out of either vegetative or minimally conscious state. Although they
remained fully dependent for care needs, carer burden was reduced and all
patients were able sustain a seating regimen. No minimal clinically important
difference was observed in 85 out of 120 joint ranges measured (70.8%). Positive
outcomes were observed in only 14 joints (11.7%) and negative outcomes in 21
joints (17.5%). CONCLUSION: At present, there is a paucity of evidence regarding
physiotherapy efficacy to inform the management of patients in vegetative or
minimally conscious state. Clearer agreed definitions of clinically important
difference in passive range of movement are required to allow better
interpretation of outcomes. Interventions should be aimed at minimising carer
burden and developing individualised disability management programmes. Further
research documenting the long-term outcomes in such patients is warranted.

Langue : ANGLAIS