A Survey of Rationales For and Against Hand Splinting in Hemiplegia

Abstract

This study investigated rationales underlying splinting decisions involving patients with hemiplegia. The survey incorporated a limited-choice, multiple-option questionnaire based on the case study of a man with a left hemiparesis at three hypothetical stages of recovery. Ninety-three occupational therapists who answered indicated whether they would or would not recommend a splint at each stage, and selected one or more reasons for their decisions. The respondents fell into three major categories: those who would 1. never splint, 2. always splint, and 3. splint only in the presence of moderate to severe spasticity. Those with longer clinical experience reflected more tendency to splint. The results indicated conflicting practices in splinting and showed the need for further clinical research in this area.

Neurorehabilitation splinting: Theory and principles of clinical use

“…-To protect joint integrity by immobilising the joint which is believed to decrease mechanical irritation caused by overstretching of a joint. Overstretching is thought to occur due to decreased proprioception within the joint following acquired brain impairment [4,9]. -To reduce pain [6,9,10].…”

“…Overstretching is thought to occur due to decreased proprioception within the joint following acquired brain impairment [4,9]. -To reduce pain [6,9,10].…”

Spasticity after stroke: Physiology, assessment and treatment

“…Several types of orthoses (also called splints) exist but, as with physiotherapy, no practical guidelines have been defined so far. The aims of splinting are reductions in spasticity and pain, improvement of function, compensation for protective sensation and prevention of contracture and deformity [85]. The principal advantage of orthoses is the duration of their effectiveness, because they can be placed and left for several hours without the presence of a physiotherapist or nurse.…”

Hand Splints and Cerebral Spasticity: A Review of the Literature

“…Two rationales for hand splinting in the presence of spasticity have emerged in a review of the literature between 1911 and the present (Neuhaus, et al, 1981). The first, labelled as the biomechanical approach, stresses prevention of deformity secondary to contractures and pain through the use of a mechanical device, by focusing on the elastic elements of muscle tone.…”

“…The use of hand splints to treat cerebral spasticity in the upper extremity is recognized by occupationa therapists to be a controversial treatment technique (Hopkins & Smith, 1983;Neuhaus, et al, 1981;Todd, & Davies, 1982;Trombly, & Scott, 1983). A paucity of research, methodological weaknesses in study designs, and contradictory results from investigations have added to the confusion about the direction of practice.…”