Hand Splints and Cerebral Spasticity: A Review of the Literature

Langlois, Sylvia; MacKinnon, Joyce R.; Pederson, Linda L.

doi:10.1177/000841748905600304

Cited by 15 publications

(9 citation statements)

References 19 publications

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“…The most commonly used splints fall into the categories of volar and dorsal splints, splints involving a finger spreader principle, and those using a cone (Langlois, MacKinnon & Pederson, 1989). Since they found no reduction in the EMG activity after the application of various splint designs, they concluded that there was not an immediate reduction of spasticity; however, they based this conclusion on the assumption that EMG alone can indicate spasticity.…”

Section: Splintingmentioning

confidence: 99%

The Effects of Splinting on the Spastic Hemiplegic is Hand: Report of a Feasibility Study

Langlois¹,

Pederson²,

MacKinnon³

1991

Can J Occup Ther

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Hand splints are used by occupational therapists as a method of reducing the increased muscle tone of the upper extremity following stroke. However, the paucity of research and inconsistent findings examining the effects of splinting on spasticity has resulted in this technique being a controversial one. Many parameters of splinting need to be investigated, such as the type of splint, the duration of use, and wearing schedules. This feasibility study was conducted to pretest instruments and procedures investigating the effects of a finger spreader on the spastic musculature of the wrist and to examine trends in spasticity associated with variables, including a splint wearing schedule, expectations and satisfaction with the splint, and compliance.Nine subjects were randomly assigned to three groups defined by wearing schedules of twenty-two, twelve, and six hours per day. The greatest change in the level of spasticity was noted in the group wearing the splint for twenty-two hours. However, this trend was not statistically significant. A statistically significant relationship was found between expectations of the splint and compliance to the wearing schedule. Satisfaction with the splint outcome and therapeutic interaction was also observed to have a statistically significant relationship with compliance. This indicates that the procedures and measures designed for this study are worth pursuing in future research. RÉSUME Les orthèses de la main sont utilisées par les ergothérapeutes comme méthode servant à réduire l'augmentation du tonus musculaire du membre supérieur suite à un accident cérébro-vasculaire; toutefois, le manque de recherche à ce sujet de même que les résultats contradictoires concernant les effets de l'utilisation des orthèses" sur la spasticité, ont soulevé une controverse sur cette technique. Plusieurs paramètres ayant trait à l'utilisation des orthèses doivent être étudiés, tels que le type d'orthèse, la durée et l'horaire d'utilisation. Cette étude de faisabilité a été entreprise avec des instruments ét des procédures pré-test pour évaluer les effets d'une orthèse d'écartement des doigts sur la musculature spastique du poignet et pour examiner les tendances de la spasticité associée à des variables incluant un horaire de port d'orthèse, les attentes et la satisfaction en rapport avec l'orthèse et l'observance de l'horaire.Neufs sujets ont été assignés au hasard à trois groupes définis suivant des horaires de port d'orthèse allant de 22 heures, à 12 heures et à 6 heures par jour. Le changement le plus remarquable du degré de spasticité a été observé dans le groupe portant l'orthèse pendant 22 heures; toutefois, cette tendance n'a pas obtenu de signification statistique. Une relation significative au plan statistique a été relevée entre les attentes concernant l'orthèse et l'observance de l'horaire du port d'orthèse. On a noté que la satisfaction en rapport avec les résultats de l'orthèse de même que l'interaction thérapeutique ont une relation statistique significative avec l'observance de l'hor...

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Section: Splintingmentioning

confidence: 99%

The Effects of Splinting on the Spastic Hemiplegic is Hand: Report of a Feasibility Study

Langlois¹,

Pederson²,

MacKinnon³

1991

Can J Occup Ther

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“…Volar splint [14][15][16] The resting volar splint was one of the earliest splint designs which attempted to reduce spasticity by placing a muscle under constant stretch with increased tone. This excessive stretching of spastic muscles was thought to cause their muscle spindles to rebase so that they would become less sensitive to stretching.…”

Section: Splint Descriptionmentioning

confidence: 99%

“…This excessive stretching of spastic muscles was thought to cause their muscle spindles to rebase so that they would become less sensitive to stretching. 16 Dorsal splint 15,16 Using their rationale, a dorsal splint is expected to facilitate the forearm's extensor musculature by cutaneously stimulating the dorsal aspect and inhibiting the flexor muscles. 16 Finger spreader 16 The use of a foam finger spreader to cover the fingers and thumb is recommended; this role is suggested to encourage extensor muscles and to prevent flexor muscles.…”

Section: Splint Descriptionmentioning

confidence: 99%

“…16 Dorsal splint 15,16 Using their rationale, a dorsal splint is expected to facilitate the forearm's extensor musculature by cutaneously stimulating the dorsal aspect and inhibiting the flexor muscles. 16 Finger spreader 16 The use of a foam finger spreader to cover the fingers and thumb is recommended; this role is suggested to encourage extensor muscles and to prevent flexor muscles. 16 Firm cone 16 The use of a firm cone inserted in the palm of the hand to minimize flexor spasticity has resulted in excessive pressure on the entire flexor surface of the fingers, which was thought to inhibit the flexor muscles.…”

Section: Splint Descriptionmentioning

confidence: 99%

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Effectiveness of hand splints on upper limb skills and functional activities in children with cerebral palsy: a review

Kumari

Surbhi

Saharawat

2021

Int J Community Med Public Health

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Cerebral Palsy is a non-progressive neurological disorder in which children may experience similar physical limitations, including those related to upper limb skills that affect the child's ability to participate in age-specific activities. The use of hand-splints in children with neurological conditions is little reported, they continue to be widely used to improve upper limb skills and functional activities. This review was done to investigate the use and effects of hand splints in Cerebral Palsy patient as orthotic treatment found to be very positive result in correcting and maintaining the achieved results. Electronic database search was conducted using Google scholar, Science direct, Pub Med, Cochrane Library and reference lists from all retrieved articles. Common problems in upper limb due to CP are flexion contractures of the fingers and wrist due to spasticity, pronation deformity of the forearm, thumb-in-palm deformity and hand-related disabilities, all lead to decrease in grip and muscle strength. Hand splints are often used to help a weak or ineffective joint or muscle to enhance a person's arm or hand posture, mobility, quality of motion, and function. The findings suggest that children with CP experience increased grip strength and fine motor dexterity when using different hand splints. This review summarizes the present state of understanding the extent to which orthotic management in CP can improve in the patient’s skills and functional activities by improving the muscle strength and hand function, also offers clinical suggestions for prescribing orthosis in order to optimize efficacy.

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“…Although clinical observations suggest that tone is reduced with splmts, experimental evidence is scarce and studies have not determined the most effective design (17)(18)(19). Additionally, whether static splmtmg can actually predispose to joint stiffenmg, muscle atrophy, and fixed joints positioning remams controversial (17,19). Orthoses control joint instability and may alter the loadmg of a limb to prevent stretch reflex activity m antagonist muscles.…”

Section: Physical Therapymentioning

confidence: 99%

Therapeutics in the Management of Spasticity

Gelber¹,

Jozefczyk²

1999

Neurorehabil Neural Repair

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Spasticity is commonly defined as a velocity-dependent increase in tonic stretch reflexes that results from a variety of disorders affecting the brain and spinal cord. Treatment of spasticity is generally considered when the increase in tone interferes with functional activities, such as positioning, mobility, or daily cares, when it is painful, or when it leads to complications such as contractures or skin breakdown. This review discusses the pathophysiology of spasticity and details the various treatments available, including physical and occupational therapy modalities, use of splints and orthoses, oral and intrathecal medications, nerve blocks, botulinum toxin injections, and orthopedic and neurosurgical interventions.Neurorehabilitation and Neural Repair 1999;13:5-14 © 1999 Demos Medical Publishing Spasticity results from a variety of common central nervous system (CNS) insults, including stroke, traumatic bram injury, cerebral palsy, multiple sclerosis (MS), and spinal cord injury. It is commonly defined as a motor disorder characterized by a velocity-dependent increase m tonic stretch reflexes associated with exaggerated tendon jerks, and is often accompanied by abnormal cutaneous and autonomic reflexes, muscle weakness, lack of dexterity, fatigability, and co-contraction of agonist and antagomst muscles (1,2). Spasticity in and of itself is not always detrimental. For example, in some patients spasticity may help prevent muscle atrophy and calcium loss from bone, help decrease edema and the risk of deep vein thrombosis, and assist cardiovascular conditioning. In individuals with marked muscle weakness, an increase m muscle tone m antigravity muscles may actually facilitate transfers, standing, and ambulation. In such patients treatment From the 5530 not only may be unnecessary but also may worsen functional abilities.In other individuals spasticity may have negative consequences, interfering with rehabilitation and activities of daily livmg (ADLs). Spasticity may cause pain, mcrease the risk of fractures, and contribute to the development of decubitus skin ulcers. Increased disability may also result from spasticity-related impairment of posture, abnormal quality of movement, painful spasms, and poor hygiene (3,4). Treatment of spasticity is often considered m these patients. The following is a review of the pathophysiology of spasticity and pharmacologic and surgical management strategies that may be considered for patients in whom treatment is deemed appropriate. PhysiologyMuscle tone, which is defined as the resistance to passive muscle movement, is modulated by both peripheral and CNS influences on the alpha motor neuron in the spmal cord (5). The pathways that regulate tone are similar to those that regulate voluntary and involuntary motor movements and, m essence, involve the spmal reflex arc. For the purpose of illustration, if one considers at UNIV CALIFORNIA SAN DIEGO on June 13, 2015 nnr.sagepub.com Downloaded from

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Hand Splints and Cerebral Spasticity: A Review of the Literature

Cited by 15 publications

References 19 publications

The Effects of Splinting on the Spastic Hemiplegic is Hand: Report of a Feasibility Study

The Effects of Splinting on the Spastic Hemiplegic is Hand: Report of a Feasibility Study

Effectiveness of hand splints on upper limb skills and functional activities in children with cerebral palsy: a review

Therapeutics in the Management of Spasticity

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