Response to stretch of hypertonic muscle groups in hemiplegia

Objective Methods of Muscle Tone Diagnosis and Their Application-A Critical Review

"Muscle tone" is a clinically important and widely used term and palpation is a crucial skill for its diagnosis. However, the term is defined rather vaguely, and palpation is not measurable objectively. Therefore, several methods have been developed to measure muscle tone objectively, in terms of biomechanical properties of the muscle. This article aims to summarize these approaches. Through database searches, we identified those studies related to objective muscle tone measurement in vivo, in situ. Based on them, we described existing methods and devices and compared their reliability. Furthermore, we presented an extensive list of the use of these methods in different fields of research. Although it is believed by some authors that palpation cannot be replaced by a mechanical device, several methods have already proved their utility in muscle biomechanical property diagnosis. There appear to be two issues preventing wider usage of these objective methods in clinical practice. Firstly, a high variability of their reliability, and secondly, a lack of valid mathematical models that would provide the observed mechanical characteristics with a clear physical significance and allow the results to be compared with each other.

Comparative Effects of Three Hand Splints on Bilateral Hand Use, Grasp, and Arm-Hand Posture in Hemiplegic Children: A Pilot Study

Enhancement of hand function in cerebral palsied children is a priority of occupational therapists working with this population. While splinting is used as an adjunct to active treatment with many other patient groups, it is not as consistently used with these children. This pilot study was designed to investigate the effects of hand splinting on bilateral hand use, grasp skill, and arm-hand posture in hemiplegic cerebral palsied children, using three different splints: the orthokinetic cuff, the short opponens thumb splint, and the MacKinnon splint. Each was selected based on its reported utility in reducing spasticity and thereby enhancing function. A counterbalanced experimental design was used with the 12 subjects wearing all three splints in a randomly assigned order. Splints were worn 8 hours per day for 6 weeks, with a 2-week interval between splints. Measures were developed for documentation of the three dependent variables. Analysis of the data revealed no significant relationship between splint type and change in the dependent variables. However, when scores for clusters of subjects were analyzed significant differences in response to the splints were identified Improvement in bilateral hand use was associated with the orthokinetic cuff and the MacKinnon splint; grasp skill improved most significantly with the MacKinnon splint. Arm-hand posture did not seem to be affected by splint wear. The study was limited by a lack of standardized measures of bilateral hand use and grasp skill for children, suggesting a need for development of such measures In addition, further investigation of the effectiveness of the MacKinnon splint on improving functional skills with cerebral palsied children is indicated.

A Survey of Canadian Occupational Therapists' Use of Hand Splints for Children with Neuromuscular Dysfunction

This survey was designed to identify the current practice of Canadian occupational therapists who have identified themselves as working in paediatrics to determine: (1) what hand splints they use with children who have neuromuscular dysfunction; (2) what influences the therapists' selection of splints; (3) what therapy goals the therapists associate with the splints they use; and (4) what relationships exist between therapists' years of clinical practice and post-graduate training and the splints used. Questionnaires were mailed to 399 occupational therapists across the ten provinces and the Northwest Territories and the Yukon with a 60% return rate. Only three splints are used regularly by over 50% of the therapists. These were the resting palmar hand splint, the thumb splint, and the hard cone splint. For the remaining nine splints, over 65% of the therapists reported they had never used any of them. The major reason reported for not using these splints was a lack of familiarity. Another reason for not using hand splints was a lack of available resources (time and materials). Therapists who worked less than five years demonstrated a greater tendency to use hand splints as compared to those therapists with more years of clinical experience. The majority of therapists were employed in rehabilitation facilities with a trend toward community facilities. This pattern may in part explain the low frequency of hand splint use among therapists. Other suggestions are made for the interpretation of these results, along with questions for future research.

Aid to Independence — Hand Splint for Cerebral Palsied Children

Many cerebral palsied children lack the ability to hold a pencil independently. This paper discusses the rationale for using a functional hand splint with the very involved cerebral palsied child. Included is a description of the splint's construction with illustrations and its advantages and disadvantages.

The effects of serial casting on spasticity: a literature review

This article is a literature review of the research regarding the use of serial casting in the treatment of spasticity. Spasticity has serious consequences, which impact activities of daily living and the quality of life. Classical studies in physiology indicate that muscle tissue immobilized in the shortened position can be physiologically changed through prolonged stretch. Serial casting has proven effective in improving such factors as range of motion and clinical measures of spasticity in spastic limbs. Further research is needed to determine the most effective uses of serial casts in the treatment of spasticity.

Clinical assessment of spasticity in children with cerebral palsy: a critical review of available instruments

This study reviews the instruments used for the clinical assessment of spasticity in children with cerebral palsy, and evaluates their compliance with the concept of spasticity, defined as a velocity-dependent increase in muscle tone to passive stretch. Searches were performed in Medline, Embase, and Cinahl, including the keywords 'spasticity', 'child', and 'cerebral palsy', to identify articles in which a clinical method to measure spasticity was reported. Thirteen clinical spasticity assessment instruments were identified and evaluated using predetermined criteria. This review consists of reports on the standardization applied for assessment at different velocities, testing posture, and quantification of spasticity. Results show that most instruments do not comply with the concept of spasticity; standardization of assessment method is often lacking, and scoring systems of most instruments are ambiguous. Only the Tardieu Scale complies with the concept of spasticity, but this instrument has a comprehensive and time-consuming clinical scoring system.

Application of a Volar Static Splint in Poststroke Spasticity of the Upper Limb

OBJECTIVE

To evaluate clinical and neurophysiologic effects of 3-month reflex inhibitory splinting (RIS) for poststroke upper-limb spasticity.

DESIGN

Pretest-posttest trial.

SETTING

Outpatient rehabilitation center.

PARTICIPANTS

Forty consecutive patients with hemiplegia and upper-limb spasticity after stroke that had occurred at least 4 months before.

INTERVENTION

Patients wore an immobilizing hand splint custom-fitted in the functional position for at least 90 minutes daily for 3 months.

MAIN OUTCOMES MEASURES

Patients underwent measurement of (1) spasticity at the elbow and wrist according to Modified Ashworth Scale; (2) passive range of motion (PROM) at the wrist and elbow; (3) pain at the shoulder, elbow, and wrist using a visual analog scale; (4) spasms; and (5) comfort and time of splint application. The instrumental measure of spasticity was the ratio between the maximum amplitude of the H-reflex and the maximum amplitude of the M response (Hmax/Mmax ratio).

RESULTS

A significant improvement of wrist PROM (F=8.92, P=.001) with greater changes in extension than in flexion, and a reduction of elbow spasticity (F=5.39, P=.002), wrist pain (F=2.89, P=.04), and spasms (F=4.33, P=.008) were observed. The flexor carpi radialis Hmax/Mmax ratio decreased significantly (F=4.2, P=.007). RIS was well tolerated.

CONCLUSIONS

RIS may be used as an integrative treatment of poststroke upper-limb spasticity. It can be used comfortably at home, in selected patients without functional hand movements, and in cases of poor response or tolerance to antispastic drugs.

Casting, splinting, and physical and occupational therapy of hand deformity and dysfunction in cerebral palsy

The treatment of hand deformity and associated dysfunction is a major focus of physical and occupational therapy for people with CP, as poor grasp and manipulation has potential to impact on many aspects of daily life. To assist therapists in analyzing patterns of movement of the wrist, finger, and thumb musculature at rest and during functional activities, five patterns of deformity commonly seen in the hypertonic hand are described. Interventions that impact on hypertonicity and associated contracture and that facilitate functional use of the hand in the presence of these deformities are discussed. The paucity of evidence from clinical trials on intervention strategies reflects in part the diversity of people with CP and the highly individual functional problems they encounter. While further research is needed on the many possible interventions and how they contribute to maximizing hand function, there is increasing evidence of the value of therapy that is directed to functional outcomes relevant to the individual.

Dynamic splint to reduce the passive component of hypertonicity

A study was conducted to test the effectiveness of a newly designed dynamic splint in reducing the passive component of hypertonus. Splinting and P-ROM exercise were compared among eight elderly subjects matched by age and sex with hemiparesis, one year after cerebrovascular accident. Spring-weighted scale measurements of the passive force of the wrist from 0 degrees flexion/extension towards flexion were used as dependent measures. Measurements were taken three days per week for six weeks. Data demonstrated that a significant reduction of hypertonus occurred among the splinted group but not the P-ROM group. A further comparison with previously published data on the effects of static splinting demonstrated that dynamic splinting led to a greater reduction of hypertonus than static splinting and P-ROM exercises.