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Long-Term Resolution of Severe Ankle Contractures Using Botulinum Toxin, Serial Casting, Splinting, and Motor Retraining

LEUNG J; STROUD K
PHYSIOTHER CAN , 2018, vol. 70, n° 2, p. 152-159
Doc n°: 187567
Localisation : Documentation IRR

D.O.I. : http://dx.doi.org/DOI:10.3138/ptc.2016-76
Descripteurs : DE76 - TRAITEMENTS / CHEVILLE, EC25 -ORTHESES DE MEMBRE INFERIEUR

Serial casting for ankle contractures is traditionally performed in
prone, a position that patients may not easily tolerate. Also, although serial
casting is effective in correcting contracture, its effect dissipates quickly.
This case report describes a procedure for performing casting for ankle
contractures in a supine or sitting position. It also describes a process that
enables the effect of serial casting to be maintained long term. Client
Description: The client was an adult who had suffered traumatic brain injury and
severe bilateral ankle contractures. Intervention: He received botulinum toxin
and serial casting for his bilateral ankle contractures, one ankle at 8 months
and the other at 13 months after the injury. He then underwent a programme of
splinting and motor training. Measures and Outcome: The client gained more than
40 degrees dorsiflexion for both ankles after receiving botulinum toxin
injections and serial casting. The improvement in ankle range enabled him to
progress to walking practice. Ankle splinting was gradually reduced. On discharge
at 25 months post-injury, the ankle joint range was maintained. Implications: The
use of botulinum toxin and serial casting, followed by an intensive programme of
splinting and motor training, may be an option to consider for effective
long-term resolution of severe contractures after acquired brain injury.

Langue : ANGLAIS

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