Brian's Story

Introduction
Spasticity in Quadriplegia and Encephalopathy is a result of pathologically increased muscle tone and primitive reflexes mediated by loss of inhibitory control.

Purpose
To report the effect of:

1. Sub-maximal (below the stretch reflex) dynamic traction in the treatment of spastic flexor-induced deformity of the arm.
2. Pronation assist on posture and function in forearm and hand.

Patient History

• 20 year old male C5-C6 patient (status post 4/95) with complication of Encephalopathy in 7/97.
• Spasticity induced postural elbow flexor/supination deformity worsened after the Encephalopathy.
• Manual stretching, static splints and E-stim used 2 months prior to custom dynamic traction bracing did not improve deformity or function.

Treatment

• Eight hours nightwear daily for both a custom made EWHO with elbow dynamic traction and pronation assist on right arm (dominant) and custom made EO with dynamic traction for left arm.
• Adjustable joints also blocked out adverse elbow posture 20° sub-maximal to PROM.
• Patient achieved approx. 8 hours wear daily through period 9/29/97 - 5/27/98.

Measurement Table (Results)
Full extension and pronation = 0°
Numbers in table indicate° lacking from full ROM.

Conclusion

• Pronation was achieved resulting in self-feeding, improved ability mobility with joystick-controlled wheelchair and computer use.
• Patient's elbow flexor and supination deformity was reduced.