Home After a Stroke
Studies of resting hand splints make me cringe when researchers ask the wrong questions. Studies done by Lannin (1) and Burge (2) asked if resting hand splints improve functional hand use. A resting splint that places the hand in one static position does not retrain the brain.
So it is not surprising that Lannin and Burge found resting hand splints produced no significant improvement on hand function tests, like the Motor Assessment Scale.
Lannin (1) also concluded "splinting has little or no effect on the loss of range of motion" (p. 113) because both subjects who did and did not wear a resting splint lost some wrist range of motion (ROM). Unfortunately, Lannin told therapists treating subjects who were wearing a resting splint to stop all passive stretching and restrict active hand exercises to 10 minutes a day.
I asked a different question. What would happen if I continue to do passive stretching and active hand exercises, but stop wearing my SaeboFlex resting splint at night? After a month of not wearing this splint it felt like my thumb was getting tighter. I resumed wearing this splint and the next morning I woke up with a ferocious ache in my thumb. Every night that I wear my splint I wake up with no resistance to thumb ROM although my thumb is tight by the evening. I don't think my resting splint has eliminated my spasticity, but I believe it has prevented a contracture.
A study by Burge (2) suggests that concluding resting splints do not prevent contractures is premature. Eight subjects who wore a splint maintained ROM while all those who did not wear a splint lost ROM. The difference in this small sample did not reach statistical significance (P = 0.128 instead of the required 0.10), but the trend refutes Lannin's conclusion. I suspect research findings conflict because some studies have a high proportion of subjects with high spasticity while other studies have more subjects with mild tone.
When I was an OT, degrees of ROM were numbers I wrote in a client's chart. Now that I am a stroke survivor a loss of ROM is terrifying because spasticity that gets out of control hurts. Botox shots hurt because a doctor uses the end of the needle to dig around in the muscle to find the best spot. Only surgery can reverse contractures created by permanent shortening of a spastic muscle. The consequences are too severe if I get this wrong.
- Lannin N, Cusick A, McCluskey A, Herbert R. Effects of splinting on wrist contracture after stroke. Stroke. 2009;38:111-116.
- Burge E, Kupper D, Finckh A, Ryerson, S, Schnider A, Leemann B. Neutral functional realignment orthosis prevents hand pain in patients acute stroke: A randomized trial. Archives of Physical Medicine and Rehabilitation. 2008;89(10):1857-1862.
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