May 5, 2015

Resting Splints Revisited

When I joined the staff of a nursing home as their first OT I opened a stroke survivor's hand after her fingernails grew into her palm because the nursing staff did not know how to inhibit her high muscle tone.  I remember that visual image when I read that stroke survivors get no benefit from wearing resting splints.  This conclusion is based on studies that looked only at hard plastic splints which are static (does not move).  After my spasticity broke two hard plastic splints, I bought a dynamic (moves) resting splint called SaeboStretch.  It bends when my muscle tone increases and goes back to its original shape when my muscles relax. 

Andringa studied a dynamic resting hand splint made by Ultraflex in Pottstown, Pennsylvania (1).  Six stroke survivors wore the dynamic Ultraflex splint for six hours during the day for six months.  Subjects reported significantly less pain at 3 and 6 months (p< 0.05).  Passive wrist extension
did not increase significantly at 3 months but was significantly greater at 6 months (p< 0.05). Subjects wore the Ultraflex splint during the day so forced disuse may have slowed recovery.  

One of Andringa's subjects illustrated the ultimate challenge of hand splinting.  He stopped wearing the splint after 4 months because it did not meet his expectations of what he thought the splint would do (1).  When clients are not told what they can expect when they wear a hand splint they are free to imagine the outcome.  Read the rationales for splinting in Are Resting Splints a Waste of Money?

 1. Andringa A, Ingrid G, Van de Port, Meijer J. Tolerance and effectiveness of a new dynamic
    hand-wrist orthosis in chronic stroke patients. NeuroRehabilitation. 2013;33(2):225-231.

1 comment:

  1. Awww, that's sad. When I was in nursing school, one rotation was in a nursing home. Several of the patients had hands that wouldn't open. :( we were instructed to try to open all of the residents hands and place a tennis ball inside when getting them ready for the day. That was the only proactive measure I saw there...never a therapist of any kind or anyone that actually knew anything. So sad! :(