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Splinting for Spasticity

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

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Splinting for Spasticity

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  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

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

  5. 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

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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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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