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.


METHODS
Pretest-posttest trial.


METHODS
Outpatient rehabilitation center.


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


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


METHODS
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.
Pizzi
Assunta
A
Department of Neurorehabilitation, Fondazione Don Carlo Gnocchi Onlus IRCCS, Centro S. Maria agli Ulivi, Pozzolatico (Firenze), Italy. apizzi@dongnocchi.it
Carlucci
Giovanna
G
Falsini
Catuscia
C
Verdesca
Sonia
S
Grippo
Antonello
A
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006181:H-Reflex; D006429:Hemiplegia / Q000209:etiology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D009126:Muscle Relaxation / Q000502:physiology; D009128:Muscle Spasticity / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D018482:Muscle, Skeletal / Q000503:physiopathology; D026741:Physical Therapy Modalities; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D018570:Risk Assessment; D012720:Severity of Illness Index; D013165:Splints; D020521:Stroke / Q000150:complications / Q000175:diagnosis; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D034941:Upper Extremity