Spastic Muscle Overactivity in a Patient With a Chronic Disorder of Consciousness After Severe Traumatic Brain Injury Successfully Treated with Acupuncture: A Case Report

TL;DR

A 70-year-old woman with chronic disorder of consciousness and spastic muscle overactivity after severe brain injury showed improvement with acupuncture treatment.

Contribution

This case report demonstrates acupuncture's potential to reduce spastic muscle overactivity in patients with chronic disorder of consciousness after traumatic brain injury.

Findings

Acupuncture improved passive range of motion in the patient's elbow joints over 20 weeks.

Ultrasound elastography showed reduced muscle stiffness after acupuncture sessions.

The patient's spastic muscle overactivity and hyper stretch reflex showed gradual improvement.

Abstract

Spastic muscle overactivity (SMO) is a frequent retractable complication in patients with prolonged disorder of consciousness (DOC) after severe traumatic brain injury (sTBI). Here, we describe a patient with DOC and SMO after sTBI successfully treated with adjunctive acupuncture. A woman in her 70s with chronic DOC, corresponding to a minimally conscious state (MCS), and limb SMO after severe TBI due to a traffic accident was admitted to our hospital six months after the injury and received multiple care interventions including physiotherapy and nurse care. However, her SMO in the extremities with decorticated posture, in which bilateral elbow joints were flexed and bilateral knee joints were extended, remained. The passive range of motion (ROM) of bilateral elbow joints decreased. Her DOC also remained in MCS. Thus, acupuncture was implemented twice weekly for 20 weeks to improve SMO and promote arousal 30 months after injury. Modified Tardieu scale (MTS) during right elbow extension was measured before and after each acupuncture session. The maximum passive ROM (MTS-R2) gradually increased during the acupuncture period. The catch angle (MTS-R1), which indicates the influences of the hyper stretch reflex, also gradually reduced. The ROM limitation and the catch angle trended to decrease immediately after each acupuncture session. Ultrasound shear-wave elastography of the right brachial biceps muscle (BBM) at the 28th acupuncture session showed a reduction of shear-wave speeds immediately after the session, indicating that acupuncture reduced BBM stiffness. Her DOC state remained MCS. In the presented case, the adjunctive acupuncture therapy reduced SMO after severe TBI. Acupuncture may be beneficial for such patients. A large cohort study is warranted to confirm the effects of acupuncture on SMO in patients with DOC after sTBI.

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