These pictures are of a little girl I met in China who has Cerebral Palsy. Her clinicians took me to see her because of her "deformed, twisted back, right elbow and both hands." They were hopeful that my experience with contracture management would provide some relief for the girl.
The first thing I did was to find a little straight backed chair and have them to sit her up with good 90 degree Pelvic tilt. As you can see, all the neurological tone that was twisting her spine and upper body was relaxed – notice her right hand! Her left hand and right elbow had already sustained a moderate amount of shortened tissue so they were fit with Restorative Medical’s NeuroFlex® Contracture Management splints, but positioning her body in an upright position with good 90 degree pelvic tilt was all the rest of her body needed.
Every patient is different and some respond better than others to positioning, but we use the same basic guidelines with all Restorative patients. As close to upright positioning as possible. Nothing rigid. Gentle stretching, and never beyond the stretch threshold. Treatments must be comfortable and not present a potential for pressure. Splints must have "Flex" properties with memory. As Dr. Ken Mook, a prominent physiatrist in Louisville Kentucky notes "I have found that a static, rigid splint is not effective in controlling spasticity because it provides a persistence of a spastic event by not allowing the muscle to shorten. A splint that has static properties with some dynamic "give" during a spastic event allows the muscle to shorten, thereby the spastic event regresses, and yet the splint maintains the proper positioning of the joint. The NeuroFlex Restorative braces made by Restorative Medical are the best I’ve seen and used with my patients. I whole-heartedly recommend this company’s products for bracing of limbs with spasticity."
When nerves are damaged in the Central Nervous System (brain and/or spinal cord) they may cause muscles to contract with no message getting back down from the brain/spinal cord to make them relax. This is what we refer to as neurological tone or "tone." This tone begins the 3rd day after many Central Nervous System injuries. If we stop it then with the appropriate technology, we can prevent most if not all of the life-altering deformities that might occur. If the person has already developed shortened tissue, we begin to work them back toward normal alignment. Tone can result in shortened tissue. Tone and/or shortened tissue result in a loss of range of motion of the joint(s)/body parts. Loss of range of motion is commonly referred to as "contracture." Contractures in neurological patients are preventable and very treatable. Neurological patients are those with conditions like Cerebral Palsy; Multiple Sclerosis; Traumatic Brain Injury, stroke and other injuries to the brain; Parkinson’s; Dementia; Spinal Cord Injury and end stage Alzheimer’s disease. When we talk about Orthopedic/Rehab treatment we talk in days and weeks, but when we talk about Restorative patient’s treatment it is months and years.
About the Guest Author: Karen L. Bonn, RN, COF and CFO at Restorative Medical, Inc. (RMI). Headquartered in Brandenburg, Kentuckym, RMI designs and manufactures medical splints and braces for treating patients with lost range of motion resulting from immobility and diagnoses like cerebral palsy, traumatic brain injury, spinal cord injury, stroke, Parkinson’s disease and Alzheimer’s disease. RMI pioneered the massage and gentle stretch approach to treating contractures, as opposed to the old range-of-motion (ROM) exercises. MMAR Medical is grateful to Karen Bonn and RMI for their invaluable expertise as well as their philanthropic service to those in need around the globe. You can learn more about Restorative Medical’s NeuroFlex® Contracture Management elbow splint here.