splinting for spasticity chapter 14 somaya malkawi, phd
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Splinting for Spasticity
Chapter 14Somaya 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
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