Tuesday, October 7, 2008

The Splint That Bounces Back

The wrists and hands of stroke survivors are
always a challenge. In human beings the powerful muscles that close the hand and bend the fingers are essential for everything from climbing to carrying to to pulling. But after stroke, just like many of the muscles on the affected side, these large wrist and finger bending muscles get spastic. And when they do they overpower the much smaller muscles that extend the wrist and fingers.

After stroke the fingers and wrist are flexed almost all the time and these muscles shorten and the wrist and fingers become even harder to straighten.

The way occupational therapy has traditionally dealt with this problem is to splint the wrist and fingers. Occupational therapists (OT's) use a material called thermoplastic which is shaped into what is considered a good position for the wrist and fingers.

But there's a problem with these splints. First of all, the splint is only as good as the OT's skill. Second these are static/rigid splints; that is, if the fingers get more flexible these rigid splints don't take advantage of these gains. Conversely if range of motion is lost and the fingers get tighter the splint does not reflect that change either. This can be damaging to the tissue around the fingers and wrist as the hand is forced into a rigid splint that's too "small".

You could hire an OT every few months to fabricate a new splint, but that gets costly.

I'm actually a big fan of a product called the SaeboStretch. This split is not static. It moves as your hand moves. If you want to bend your fingers, you can. This splint is made out of material that is flexible but elastic. That is, it can be bent but it always wants to return to its original position. This provides low-load pressure into the proper position. In this way this splint takes advantage of any increased elasticity in muscles and other soft tissue. I've had experts on splinting tell me point-blank that this is the only off-the-shelf splint that they'll recommend.

You can find information on the splint here.

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