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How Does Spasticity Affect Patients with Disorders of Consciousness?

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Coma and Disorders of Consciousness

Abstract

Spasticity is a frequent issue encountered by brain-damaged patients, arising from an anarchic reorganization of the central nervous system that may significantly alter motor function. While it is well described in patients with a lesion of the descending corticospinal system, little is known about the occurrence and physiopathology of this disorder in patients with more complex brain lesions and disorders of consciousness (coma, unresponsive wakefulness syndrome, and minimally conscious state). Most of the time, these patients are bedridden and lack voluntary motor command which favors spasticity to occur and may lead to complications including pain, loss in range of motion, or bed sores. Given the inability for many of these patients to express their pain or discomfort and knowing that spastic syndromes may restrain them to express signs of consciousness, the multimodal treatment of this spasticity is crucial for their management. In the present chapter, we describe the physiopathology and the current available treatments of spasticity in this specific population of severe brain-injured patients with disorders of consciousness.

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Abbreviations

CNS:

Central nervous system

DOC:

Disorders of consciousness

EMG:

Electromyogram

MAS:

Modified Ashworth Scale

MCS:

Minimally conscious state

MTS:

Modified Tardieu Scale

ROM:

Range of motion

TBI:

Traumatic brain injury

UMN:

Upper motor neuron

UWS:

Unresponsive wakefulness syndrome

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Authors and Affiliations

  1. Coma Science Group, GIGA Research Center and Neurology Department, University and University Hospital of Liège, Liège, Belgium

    Géraldine Martens M.Sc, Steven Laureys M.D., Ph.D. & Aurore Thibaut Ph.D.

  2. Department of Physical Medicine and Rehabilitation, University Hospital of Liege, Liege, Belgium

    Marguerite Foidart-Dessalle M.D.

  3. Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, 79/96 13th avenue, 02129, Charlestown, MA, USA

    Aurore Thibaut Ph.D.

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  1. Géraldine Martens M.Sc
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  2. Marguerite Foidart-Dessalle M.D.
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  3. Steven Laureys M.D., Ph.D.
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  4. Aurore Thibaut Ph.D.
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Correspondence to Aurore Thibaut Ph.D. .

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  1. Department of Research, Casa Colina Hospital and Centers for Healthcare, Pomona, California, USA

    Caroline Schnakers

  2. GIGA Consciousness, Coma Science Group & Neurology Department, Liège, Belgium

    Steven Laureys

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Martens, G., Foidart-Dessalle, M., Laureys, S., Thibaut, A. (2018). How Does Spasticity Affect Patients with Disorders of Consciousness?. In: Schnakers, C., Laureys, S. (eds) Coma and Disorders of Consciousness. Springer, Cham. https://doi.org/10.1007/978-3-319-55964-3_7

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