Splinting for Spasticity Chapter 14 Somaya Malkawi, PhD

Evidence of effectiveness Lack of consensus Disagreement on splint design, surface of application, wearing time, and schedule, joints to be splinted, materials, splints components Systematic review: insufficient evidence to either support or refute the effectiveness of hand splinting for spastic hand in patients who are not receiving prolonged stretches to their UE

What is spasticity It is UMNL CVA, HI, SCI, CP Cause deformity Limit functional movement Biomechanical approach to tx: Splinting Sensory feedback from splint  alter muscle tone  normal movement pattern  reflex inhibiting patterns , inhibit flexor muscles inhibit spasticity

Variety of elements Platform design Finger and thumb position Static and dynamic prolonged stretch Materials properties

Forearm platform position Affects wrist control as well as the fingers If only fingers splinted into extension, wrist will flex bcz flexor tendons cross the wrist, fingers and thumb Literature focus on volar and dorsal based forearm platfomr Ulnar based is appearing but not in research yet

Fig 14-1 Hard cone is attached to an ulnar platform: spasticity cone splint

Forearm platform position Volar: support transverse metacarpal arch and material does not cover styloid process Dorsal: free palm for sensory feedback, easier to remove if spastic, more even distribution of pressure Ulnar: ulnar deviation, more even distribution of pressure

Finger and Thumb position Finger spreader and hard cone Thumb: radial or palmar abd NDT: RIP to facilitate ext. muscle tone Palmar abd is BETTER than radial abd Greater fitting security, thumb more comfortable, equal results in spasticity reduction Some include the wrist  avoid tranfer of spasticity Fig 14-2 finger spreader designs

Cones Firm cone  constant pressure over palm area Cone: inhibitory effect on flexor muscles Total contact with cone provide maintained pressure over flexor surface of palm  desensitize hypersensitive skin Made from card board or LTT Fig 14-3

Cones Larger end placed ulnarly No forearm support with cones in literature Fig 14-4 : Orthokinetic wrist splint – volar platform Fig 14-5 adapted hard cone design provides pressure on MCP heads

Static and Dynamic prolonged stretch Research shows that positioning the wrist and finger flexors in gentle, continuous stretch reduce the passive component of spasticty Static stretch (max, or submax) or active stretch (fig 14-20) showed to be effective

Serial and inhibitive casting Periodic cast change will increase ROM and decrease contractures Submaximal Range (5-10 degrees below max) Cast change ranges from every day (currect contractures to every 10 days in chronic contractures Stop if no change in ROM in several casts Prolonged continuous stretch will lengthen muscles and soft tissue

Materials and properties Plaster: cheap Fiber glass costly, needs training Pneumatic pressure arm splint Foam material Neoprene material Check fig 14-23, 24, 25