Contracture and Spasticity Management using ORLAU Standing Frame

Mr. Andrew Roberts, Mr. Keith Miller, Prof Anand Pandyan and Mr. William Bromwich

Traumatic brain injury is frequently accompanied by the development of lower joint limb deformities as a result of weakness and spasticity (muscle overactivity). As a result of weakness the patients are often unaContracture and Spasticity Management using ORLAU Standing Frame_Andrew Robertsble to move (e.g. walk, transfer from a bed to a chair) and the excessive muscle activity then leads to a joint (or joints) being held in a fixed position. The resulting functional impairments associated with joints being held in a fixed position lead to rapid, and in some extreme cases irreversible, joint deformities called contractures. Contractures frequently occur at the hip, knee and ankle. Standing frames are commonly used to prevent these contractures and, if they are not permanent, reduce their magnitude once they have developed. Vibration has been reported as being a beneficial addition standing frame use for patients with cerebral palsy, stroke and spinal cord injury, conditions which are all complicated by the development of lower limb contractures in association spasticity. The vibration has been shown to reduce spasticity in the short term but long term effects have not been studies. The evidence leads us to belive that provinding a vibratotry stimulus to the limbs when a patient is on a standing frame will enhance the effectiveness of standing frame treatment. The ORLAU standing frame, a device in commonly clinical use, has been used with adults and children over the past 30 years. The engineers in ORLAU have the capability to intergate the vibratory stimulus into the existing standing frame so that a controlled delivery of vibration to the skeleton and muscles of the lower limbs can be given. Our pilot project will design and develop such a device and then capture the user experience and short term efficacy with regards to range of motion and measures of lower limb spasticity in three patients with traumatic brain injury.