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Splinting for Spasticity Chapter 14 Somaya Malkawi, PhD.

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Splinting for Spasticity Chapter 14 Somaya Malkawi, PhD
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Page 1: Splinting for Spasticity Chapter 14 Somaya Malkawi, PhD.

Splinting for Spasticity

Chapter 14Somaya Malkawi, PhD

Page 2: 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

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

Page 3: Splinting for Spasticity Chapter 14 Somaya Malkawi, PhD.

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

Page 4: Splinting for Spasticity Chapter 14 Somaya Malkawi, PhD.
Page 5: Splinting for Spasticity Chapter 14 Somaya Malkawi, PhD.
Page 6: Splinting for Spasticity Chapter 14 Somaya Malkawi, PhD.

Variety of elements

Platform design Finger and thumb position Static and dynamic prolonged

stretch Materials properties

Page 7: Splinting for Spasticity Chapter 14 Somaya Malkawi, PhD.

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

Page 8: Splinting for Spasticity Chapter 14 Somaya Malkawi, PhD.

Fig 14-1

Hard cone is attached to an ulnar platform: spasticity cone splint

Page 9: Splinting for Spasticity Chapter 14 Somaya Malkawi, PhD.

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

Page 10: Splinting for Spasticity Chapter 14 Somaya Malkawi, PhD.

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

Page 11: Splinting for Spasticity Chapter 14 Somaya Malkawi, PhD.

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

Page 12: Splinting for Spasticity Chapter 14 Somaya Malkawi, PhD.

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

Page 13: Splinting for Spasticity Chapter 14 Somaya Malkawi, PhD.

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

Page 14: Splinting for Spasticity Chapter 14 Somaya Malkawi, PhD.

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

Page 15: Splinting for Spasticity Chapter 14 Somaya Malkawi, PhD.

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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