1. Splinting for Spasticity
Chapter 14
Somaya Malkawi, PhD

2. 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

3. 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

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

7. 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

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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

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