Acquired deforming hypertonia and contractures in elderly subjects: Definition and prevalence in geriatric institutions (ADH survey)

Dehail, Patrick; Simon, Olivier; Godard, Ana Lúcia Brunialti; Faucher, Nathalie; Coulomb, Y.; Schnitzler, A.; Denormandie, P.; Jeandel, Claude

doi:10.1016/j.rehab.2013.11.001

Cited by 20 publications

(20 citation statements)

References 25 publications

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“…Contractures are a common condition. In institutions for elderly people in Philadelphia, 61.2% of residents have a contracture, while in France only 22% have ADH [ 2 – 3 ]. The difference in prevalence between these two studies is related to the fact that not all muscle contractures limit activities of daily living and are thus not considered as ADH.…”

Section: Discussionmentioning

confidence: 99%

“…Muscle contractures can limit activity, particularly when they affect positioning in a chair. Prolonged bed rest can cause further complications [ 3 , 21 ]. Difficulties with nursing care and hygiene (washing, changing and dressing) and pain during mobilization are often reported [ 2 , 3 , 21 – 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Contractures are common with a prevalence of 61.2% in the institutionalized elderly in Philadelphia [ 2 ]. If the contractures limit activities of daily living, they are termed acquired deforming hypertonia (ADH) [ 3 ]. In France, 22% of the institutionalized elderly have ADH of at least one muscle [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…If the contractures limit activities of daily living, they are termed acquired deforming hypertonia (ADH) [ 3 ]. In France, 22% of the institutionalized elderly have ADH of at least one muscle [ 3 ]. Contractures cause difficulty with hygiene, nursing care, dressing, transfers, positioning in a chair or standing as well as cutaneous lesions (fungal infections and bed sores) [ 1 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…In France, 22% of the institutionalized elderly have ADH of at least one muscle [ 3 ]. Contractures cause difficulty with hygiene, nursing care, dressing, transfers, positioning in a chair or standing as well as cutaneous lesions (fungal infections and bed sores) [ 1 , 3 ]. Certain chronic conditions such as severe traumatic brain injury, stroke, degenerative cerebral lesions or traumatic spinal cord injury may cause contractures [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness and Complications of Percutaneous Needle Tenotomy with a Large Needle for Muscle Contractures: A Cadaver Study

et al. 2015

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BackgroundTwenty-two percent of institutionalised elderly persons have muscle contractures. Contractures have important functional consequences, rendering hygiene and positioning in bed or in a chair difficult. Medical treatment (such as botulinum toxin injections, physiotherapy or positioning) is not very effective and surgery may be required. Surgery is carried out in the operating theatre, under local or general anaesthesia but is often not possible in fragile patients. Mini-invasive tenotomy could be a useful alternative as it can be carried out in ambulatory care, under local anaesthesia.ObjectiveTo evaluate the effectiveness of percutaneous needle tenotomy and the risks of damage to adjacent structures in cadavers.MethodThirty two doctors who had never practiced the technique (physical medicine and rehabilitation specialists, geriatricians and orthopaedic surgeons) carried out 401 tenotomies on the upper and lower limbs of 8 fresh cadavers. A 16G needle was used percutaneous following location of the tendons. After each tenotomy, a neuro-orthopaedic surgeon and an anatomist dissected the area in order to evaluate the success of the tenotomy and any adjacent lesions which had occurred.ResultsOf the 401 tenotomies, 72% were complete, 24.9% partial and 2.7% failed. Eight adjacent lesions occurred (2%): 4 (1%) in tendons or muscles, 3 (0.7%) in nerves and 1 (0.2%) in a vessel.ConclusionThis percutaneous needle technique effectively ruptured the desired tendons, with few injuries to adjacent structures. Although this study was carried out on cadavers, the results suggest it is safe to carry out on patients.

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Section: Discussionmentioning

confidence: 99%