How to manage spasticity in disorders of consciousness?

Spasticity is a major issue encountered by patients with chronic disorders of consciousness (DOC). This motor disorder appears indeed frequently after a lesion involving the central nervous system. While the prevalence of spasticity in DOC patients is reported from ranging from 59% to 89%, treatment options are still poorly studied. One of these options is the application of soft splints on the upper limb extremity. The aim of this ongoing trial is to investigate the tolerance and long-term effects of these splints. Methods: In this randomized simple-blind placebo-controlled study, patients with DOC presenting spasticity wear an active or a placebo soft splint on the spastic hand(s) for three hours a day, 5 times a week during three weeks. Primary outcome measures are the tolerance of the splint and the severity of spasticity (as measured by the modified Ashworth scale and the modified Tardieu scale). Secondary outcomes include pain and hand opening. Results: So far, 5 patients have been included and 4 are enrolled. The preliminary results show good tolerance and significant improvement in hand opening during the intervention but not at 3-weeks follow-up. A decrease in the spasticity scores is also observed in the experimental group and not in the placebo group but the difference is non-significant (p>0.05). Conclusion: This ongoing trial show that soft splints might present a short-term benefit to improve the spasticity in patients with DOC but more patient need to be included. Further studies should investigate treatment options specific to these non-communicative and bedridden patients.