Spastic co-contraction, rather that spasticity, is associated with impaired active function in adults with acquired brain injury: A pilot study

Abstract : Spasticity and spastic co-contraction are expressions of muscle overactivity that occur in spastic paresis syndrome after a brain injury. The objective of the present pilot study was to improve our understanding of the respective adverse consequences of spasticity and spastic co-contraction on motor disability. In contrary to spasticity, spastic co-contraction is strongly associated with motor impairment in subjects with brain injury. Therapies should be directed toward reducing spastic co-contraction in order to improve motor function. Objective: To elucidate the adverse consequences of spasticity and spastic co-contraction of elbow flexors on motor impairment and upper limb functional limitation. Design: A pilot case-controlled prospective observational study. Subjects: Ten brain-injured adults, and 10 healthy controls. Methods: The co-contraction index was computed from electromyographic recordings of elbow flexors during sub-maximal (25% Maximal Voluntary Contraction) isometric elbow extension. Spasticity was assessed with the Tardieu scale, upper limb limitation using a goniometer during active elbow extension, motor selectivity with the Fugl-Meyer Assessment for the upper limb, and motor function with the Action Research Arm Test. Results: Greater co-contraction occurred in patients with brain injury compared with controls. In contrast to spasticity, strong associations were found between the co-contraction index, the limitation of active elbow extension, the Fugl-Meyer Assessment, and the Action Research Arm Test. Conclusion: This pilot study suggests that spastic co-contraction rather than spasticity is an important factor in altered upper limb motricity in subjects with brain injury, leading to abnormal restricting arm movement patterns in subjects with more severe motor impairment. Practical applications directly concern the pre-and post-therapeutic evaluation of treatments aimed at improving motor skills in subjects with brain injury.