February 28, 2015

Are Resting Hand Splints a Waste of Money?

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 to stop all passive stretching and restrict active hand exercises to 10 minutes a day for subjects who were wearing the resting splint.

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 I wear my splint I wake up with no resistance to thumb ROM although my thumb is tight by the evening.  I do not think my resting splint has eliminated my spasticity, but I believe it has prevented a contracture.

Burge (2) wrote that concluding resting splints do not prevent contractures is premature.  Eight subjects in Barge's study 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 0.1), 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.  As 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. 

1.  Lannin N, Cusick A, McCluskey A, Herbert R. Effects of splinting on wrist contracture after  
     stroke. Stroke. 2009;38:111-116.
2.  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.

3 comments:

  1. I wore my resting hand splint always until I was unable to put it on because of the downward rotation of my wrist made it impossible. In spite of developing a pressure sore on my thumb. I was told to leave out the splints until it healed. Spasticity is a witch and by the time for the next set of Botox (2 months later), the wrist and thumb were immobile. Now although I can straighten the thumb manually, I've lost the wrist mobility. Splints are "helpful" only if you can wear them. The pain and suffering it caused will not be repeated.

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    1. My spasticity broke two different types of splints my OT made for me. Both splints broke at the wrist. Now I wear a SeaboStretch resting splint that is made of a "space-age" material that bends when my spasticity acts up and resumes it shape when my muscles relax. SaeboStretch is completely covered with a soft cushy fabric that makes it more comfortable than plastic splints.

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  2. I stopped wearing my resting splint at night because I experience spontaneous, spastic movement in the morning when I first wake up. This is my best time for new motion to occur - when I am relaxed and still in a dreamlike state. I can even extend my fingers fully although I am unable to extend my fingers on command. It is as if I get my best motion when I am not thinking about it. I try to fall asleep with my fingers interlaced if I don't set off the palmar relex.

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