Saturday, December 05, 2015

Splinting After Stroke? Why?

Peter G. Levine
Stronger After Stroke
Sunday, November 29, 2015

The research into splinting stroke survivors is clear: It does not work. Let’s have a look.

Forget individual studies… they don’t count for much. Rather, let’s look at the meta-analyses (or “metas”). Metas are studies of all the studies available and will quickly tell you if something works. The granddaddy of all metas, the Cochrane review, has looked at splinting after stroke. The review states,
“Nine studies with a total of 391 participants investigated the effects of splinting. The mean effect of splinting on joint mobility was 0°”


After stroke there are a number of reasons that you’re supposed to splint the wrist/hand/fingers. Here is the logic:

The survivor tends to posture with the wrist and fingers flexed (bent at the wrist and the fingers in a fist) Why do survivor’s posture like that? It has to do with the brain injury. Because the brain is no longer in full control, the stronger of the two muscle groups takes over. Imagine you have a ping pong paddle in your hand… what movement do you think is stronger, the wrist extended (like the follow through in a ping pong backhand), or the wrist forward (like the follow through in a ping pong forehand)? It’s actually the forehand/ flexion posture. OK, that’s why the wrist flexes (down, towards the forearm). What about the fingers? Same thing… the moment of the fingers to close the fingers (fist) is stronger than the movement to open the hand.

But why does this natural posture in survivors suggest to therapists that the hand and wrist be splinted? In some ways, it has to do with the same philosophy that scientific medicine has about treating everything. If she has a fever, try to cool the patient down. If she can’t sleep, give her sleeping meds. If she’s nauseous, give her a pill to reduce the nausea.  Of course, there is the opposite view. For instance we know that the immune system works better when the body is feverish, so maybe we should let the fever run its course. If someone can’t sleep, maybe there is a reason and the person should exercise. If there is nausea, maybe what the body is trying to rid itself of…should.

Let’s get back to splinting of the wrist/hand… What does the joint want to do? So the scientific perspective would be: do the opposite. What keeps joints in an extended position? Splints. So when therapists splint, they’re taking the scientific medical perspective, the science disagrees.

One last thing; I’m sure I will hear it from the pro-splinting lobby. Please save your time if you have anecdotal “splinting worked great for me” “evidence.” Unless you are willing to collect data using high reliability/validity outcome measures and have that data accepted as a result of the peer reviewed process, it is not evidence.

See the original article:

No comments:

Post a Comment