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. 

February 24, 2015

Equipment that is WalMart Cheap



When I was an OT student I was taught to shop in expensive medical catalogs.  Now that I am a stroke survivor and living on a fixed income this is the last place I look.  First I shop at local stores and then go on-line.  Merchandise designed for able-bodied people can often function as an adaptive device for a stroke survivor.  Two inexpensive items are over-the-door plastic hooks and non-slip shelf liner.  I use a plastic hook to hang a terry-cloth bathrobe on a towel bar so it is next to my towel.  Another plastic hook keeps the head of the shower hose off the floor of my tub when I'm finished showering.

If I didn't have non-slip shelf liner under the pill container it would start slipping away from me as soon as I reached in to get a pill.  I'm glad non-slip shelf liner comes in neutral colors that don't clash with my decor because I have small pieces of it all over my house.

February 13, 2015

Does Reaching a Plateau Really Happen?

Regaining a skill 11 years after my stroke made me wonder why I believed in plateaus when
I was an OT.  Here are four factors that changed my belief about recovery after a stroke.

What Has Changed.  1)  Brain plasticity will blow your mind.  Click here to learn how an adult's brain grows new stem cells every night and makes them migrate to where they are needed.
2)  There is lots of new technology like electric muscle stimulation with biofeedback (click here).
3)  Blogging lets stroke survivors share their triumphs.  My continued progress is not unique.  4)  People who have a stroke as young or middle-aged adults have higher expectations placed on them that people who have strokes in their 70s and 80s.  Family members cannot maintain their own health if they do everything for a disabled adult for decades.  Reducing the time a family can care for a stroke survivor is expensive.  Assisted living where assistance costs extra is a long-term solution many families cannot afford. 

What Perpetuates the Myth.  Therapists see clients for days or weeks.  This small window is suited to orthopedic cases like hip replacements because bones and muscles repair themselves fairly quickly.  Brain recovery takes longer because the brain is so complex.  Therapists do not see the progress stroke survivors make in the next stage of rehab (e.g. out-patient) or after therapy ends.

The Alternative.  Using the word plateau shuts down the conversation.  "Will I get better?" is an opportunity to ask if there is something a client wants to do.  Here is something I wanted.  I have baby-fine short hair so I need a good haircut.  Before I sit down in a beauty salon chair I have to back up and then straddle the wide footrest.  The chair was initially an obstacle to having a good hair day so I never get tired of defeating it.  Challenges that pushed my continued recovery were walking backwards, twisting my trunk so I can reach far behind me to grab the armrest, and sitting down with my feet 18 inches apart.

The Bottom Line.  Skill acquisition can stop because of our beliefs as well as our abilities.  My progress has slowed over the years, but I have repeatedly seen
new goals spur new gains.  This evidence has changed what I think will happen to me.   

February 3, 2015

Snow Strategies, Part 3

I was lucky.  Trenton, NJ got only 4 inches of snow from Blizzard Juno instead of the 18 inches they predicted.  I cleared my sidewalk by pushing the light fluffy snow with a small light shovel while wearing snow boots (click here).  However, clearing snow off my car is always a balance challenge.  Before I lean my chest and stomach against the car for support I don an apron I do not tie.  An arrow is pointing at a smudge mark that ended up on the apron instead of my coat.  My sound hand and forearm cannot handle the weight of a long device for pushing snow off a car so I use a shorter, lighter device designed to clean windshields.  By 2 p.m. my car was free of snow. 

As I was driving to my breakfast club the next morning I thought about the people in Maine who got clobbered with 35 inches of snow and 50 mile per winds that created tall snow drifts.  That image triggered memories from my summer vacation in Maine two years ago.  I remembered the people who smiled at me as I walked around.  Instead of pretending they did not see me, many people initiated eye contact and smiled before I did.  Perhaps people who live in a harsh climate feel a connection with people who know how to defeat adversity.