S-3-04-02
Brain Injury Rehabilitation Programs in New South Wales
Professor Dennis S Smith, Sydney Australia, and Salisbury England
During the last two years I was able to visit 17 separate Brain Injury Programs throughout New South Wales, Australia. The purpose of these visits was to evaluate the standards and effectiveness of these programs throughout the State. The program, which covers all of the populated part of NSW, is based upon the use and mobilisation of local resources in both Town and Country. It appears to be a comprehensive and economic program which deals very effectively with the heterogenous consequences of Head Injury upon the population and families of this Australian State.
S-3-04-03
THE UPPER LIMB WITH RESTRICTED MOTION AFTER BRAIN INJURY
N.H. Mayer, G. T. Wannstedt (MossRehab Hospital & Temple University, Phila., PA, USA
Abstract: Patients with an motoneuron syndrome (UMN) commonly develop limbs with restricted motion. Access to body parts for personal care and reaching targets in space are often lost. Dynamic electromyography and electrogoniometry were used to study issues of restricted motion and two types of problems emerged: problems of passive function affecting caregiving and problems of active or voluntary limb usage restricted by dyssynergy, tissue stiffness and/or weakness. Problems of passive function relate to skin maceration, breakdown, malodor and limb manipulation by caregiver or patient during caregiving. Problems of active function were diverse but often centered on impaired object acquisition because of restricted range or hand dysfunction. Masked voluntary movement was a feature of interest in some cases. Findings are consistent with the idea that the origin of limb deformity in patients with UMN reflects a net imbalance of muscular and soft tissue forces affecting joint position statically and joint movement dynamically. Weakness, dyssynergy, tissue stiffness and impaired motor control contribute as factors. Chemodenervation with botulinum toxin, neurolysis with phenol, orthopaedic transfers, lengthenings and releases and physiotherapeutic strategies that reduce restricted motion may be useful.
