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Abnormal Posturing and Potential Causes

  • Synopsis: Published: 2012-07-06 (Revised/Updated 2015-04-19) - Abnormal posturing happens with little stimulation and is a sign of serious damage to the central nervous system. For further information pertaining to this article contact: Wendy Taormina-Weiss at Disabled World.
Abnormal Posturing

Abnormal Posturing - Abnormal posturing is different from "bad posture" or "slouching." Instead, it involves holding a body position, or moving one or more parts of the body in a certain way. Abnormal posturing may be a sign of certain injuries to the brain or spinal cord.

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Quote: "Damage to, or issues with, a person's nervous system can appear as posturing when they perform certain tasks, such as walking on the sides of their feet, heels, or toes."

Abnormal posturing that happens with little stimulation is a sign of serious damage to a person's central nervous system.

'Abnormal posturing,' also referred to as, 'Pathologic posturing,' is not the same thing as slouching or having poor posture. Abnormal posturing involves a person's body position, or the movement of one or more of their body parts in a certain way. A person who experiences abnormal posturing might be exhibiting signs of certain types of injuries to their spinal cord or brain.

Abnormal posturing that happens with little stimulation is a sign of serious damage to a person's central nervous system. Damage to, or issues with, a person's nervous system can appear as posturing when they perform certain tasks, such as walking on the sides of their feet, heels, or toes. Usually, when a person's muscle contracts, the muscles on the opposite side of their joint offer resistance to the contraction. When a person experiences abnormal posturing due to damage to their spinal cord or their brain, it reduces or even prevents the muscles on the opposite side of their joint from contracting in certain muscle groups. Types of abnormal postures include the following:

Opisthotonos: Opisthotonos describes a posture where a person's back is arching and rigid and their head is thrown backwards.

Decorticate Posture: Decorticate is with the arms rigidly flexed over the "core" of the body. It can occur on one side or both and can change from Decorticate to Decerebrate and back again. Decorticate refers to abnormal flexon.

Decerebrate Posture: Decerebrate posture describes a posture where a person's legs and arms are straight out and rigid. Their head arches backward, and their toes point downward.

A person affected by abnormal posturing might alternate between postures as the condition they experience changes. Swelling or injury to a part of the person's spinal cord, brain, or nervous system are the most common causes of abnormal posturing. The type of posturing a person experiences is dependent upon the type and area of the nervous system that is involved. The causes of abnormal posturing may include:

  • Stroke
  • Head injury
  • Reye syndrome
  • Cerebral edema
  • Uncal herniation
  • Increased intracranial pressure from any cause

Decerebrate Posture

Decerebrate posture is a form of abnormal body posture involving a person's legs and arms being held out straight with their neck and head arching backwards and their toes pointing downward. The person's muscles tighten and are held rigidly. A person who experiences Decerebrate posturing has often times experienced severe damage to their brain.

People with Decerebrate posture can also experience, 'Opisthotonos,' or a severe muscle spasm of their back and neck. Opisthotonos is something that can happen in severe instances of Decerebrate posture, which people can experience on one or both sides of their body, or only in their arms. The posture might alternate as well. People may experience Decorticate posture on one side of their body, and Decerebrate posture on the other side of their body. The causes of Decerebrate posture can include:

  • A stroke
  • A head injury
  • Encephalopathy
  • A brain stem tumor
  • Hepatic encephalopathy
  • A primary or secondary brain tumor
  • Bleeding in the brain due to any cause
  • Increased pressure in the brain from any cause

Decorticate posture

Decorticate posture involves a form of posturing where a person's arms are bent and stiff, their legs are straight out, and their fists are clenched. Their arms are bent in towards their body and their fingers and wrists are bent and held onto their chest. Decorticate posture is also a sign of severe damage to the person's brain. People who have Decorticate posture should promptly seek medical attention if they have not already.

Decorticate posture is a sign that a person has experienced damage to the nerve pathway between their spinal cord and their brain. While the condition is serious, it is often not as serious as Decerebrate posture. The posturing the person presents can happen on one or both sides of their body. The causes of Decorticate posture can include the following:

  • A stroke
  • A head injury
  • A brain tumor
  • Bleeding in the person's brain
  • Increased intracranial pressure due to any cause
  • Worsening of the person's brain function that happens due to brain infections, liver damage, or other causes

Opisthotonos

Opisthotonos is a condition in which a person's body is held in an abnormal position. The person is often times rigid, arching their back with their head thrown backward. If a person who experiences Opisthotonos lies on their back, only the back of their head and their heels touch the surface they are lying on.

Opisthotonos is many times more commonly experienced by infants and children than it is by adults. It is also more exaggerated in infants and children because they have nervous systems that are less mature. Opisthotonos might be experienced by infants who have meningitis, as a sign of injury to a person's nervous system, or as a sign of reduced brain function. Additional causes of Opisthotonos can include:

  • Tetanus
  • Seizures
  • A brain tumor
  • Krabbe disease
  • Glutaric aciduria
  • Gaucher disease
  • Organic academies
  • A severe head injury
  • 'Stiff person syndrome'
  • Arnold-Chiari syndrome
  • Subarachnoid hemorrhage
  • Growth hormone deficiency
  • Severe electrolyte imbalance

Medications such as phenothiazines or other types of antipsychotic medications may cause a side effect referred to as, 'dystonic reaction.' Opisthotonos can be a part of this reaction. Rarely, infants who are born to women who consume large amounts of alcohol during pregnancy might experience Opisthotonos caused by withdrawal from alcohol.

When to Seek Medical Assistance

People who experience abnormal posturing almost always experience a reduction in consciousness as well. Any person who presents symptoms of abnormal posturing needs to be examined promptly by a medical professional. In some conditions such as a coma, the posturing may continue for an extended period of time.

While a person who presents with a form of posturing is at the hospital, emergency treatment for the posturing needs to be started right away. A physical examination of the person will be performed. Treatment includes placement of a breathing tube to provide assistance with breathing. The person will most likely be placed in the hospital's intensive care unit. The hospital will also want the person's medical history; something it will need to obtain from the person's family members. The hospital will ask questions that might include the following:

  • Is there a pattern to the posturing occurrences
  • Does the person have a history of injury, such as a head injury
  • Does the person always demonstrate the same form of posture
  • When did the person begin demonstrating this posturing behavior
  • What other symptoms occurred before, or happened during the posturing

A physical examination of the person who is experiencing posturing will include a complete nervous system and brain evaluation. The hospital will run a number of tests to include an EEG, a head X-ray, a cerebral angiography, a head MRI scan, a head CT scan, and monitoring of the pressure inside the person's brain.

Every person who experiences abnormal posturing needs to receive treatment in a hospital. Posturing is most often experienced by people who are in a coma. More subtle posturing caused by a doctor during a visit may not be as serious.

Diagnosis of and Tests for Cerebral Palsy
cerebralpalsy.org/about-cerebral-palsy/diagnosis/

"Diagnosing cerebral palsy takes time. There is no test that confirms or rules out cerebral palsy. In severe cases, the child may be diagnosed soon after birth, but for the majority, diagnosis can be made in the first two years."

Dystonias Fact Sheet
www.ninds.nih.gov/disorders/dystonias/detail_dystonias.htm

"Dystonia is a disorder characterized by involuntary muscle contractions that cause slow repetitive movements or abnormal postures. The movements may be painful, and some individuals with dystonia may have a tremor or other neurologic features."

Metachromatic leukodystrophy
www.nlm.nih.gov/medlineplus/ency/article/001205.htm

"MLD is usually caused by the lack of an important enzyme called arylsulfatase A. Because this enzyme is missing, chemicals called sulfatides build up in and damage the nervous system, kidneys, gallbladder, and other organs. In particular, the chemicals damage the protective sheaths that surround nerve cells."



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