Upper Extremity Orthoses in Stroke Rehabilitation

Upper Extremity Orthoses in Stroke Rehabilitation

Upper Extremity Orthoses in Stroke Rehabilitation

May 10, 2023

Static Hand-Wrist Orthosis (Rest Splint)

A Static Hand-Wrist Orthosis (Rest Splint) is often used to position the hand and wrist after a stroke. It is recommended to hold the wrist at 20-30 degrees of extension, the metacarpophalangeal (MCP) joint at 40-45 degrees of flexion, the interphalangeal joints at 10-20 degrees of flexion, and the thumb in opposition. Although Static Hand-Wrist Orthosis may be effective for stroke patients in the long term, therapists should analyze its effects on the patient during the acute and subacute periods. These orthoses can be used at night to prevent soft tissue contracture. Still, they should not be used during the day as they surround the surface of the hand, spontaneous inhibiting activity, sensory input, and hand management. Such use may encourage learned non-use of the hand.

Inhibitory Hand-Wrist Splint

Snook developed the Inhibitory Hand-Wrist Splint based on Bobath’s reflex inhibition pattern principle, which current research does not support. The splint positions the wrist in 30 degrees of extension, the MCP joints in 45 degrees of flexion, the interphalangeal joints in full extension, the fingers in abduction using a spacer, and the thumb in abduction and extension. If the wrist has a flexion contracture, it can be positioned neutrally.

Scientific studies have shown that the inhibitory hand-wrist splint has a reducing effect on muscle tone. Although a decrease in muscle tone is typically observed immediately after the splint is applied, muscle tone tends to increase gradually when the splint is worn for long periods. Therefore, it is recommended to wear the inhibitor wrist splint intermittently.

Shoulder Strap

The Shoulder Strap is used to support the paralyzed extremity, and static support is typically provided by a fabric sling that wraps around the shoulder and arm. The arm should be positioned in adduction, the elbow in 90 degrees of flexion, and the shoulder in internal rotation. However, since it keeps the shoulder in adduction and internal rotation, it may cause adhesions in the shoulder, especially if there is spasticity. Therefore, daily range of motion exercises should be done to prevent joint stiffness. The shoulder strap is the simplest shoulder orthosis; many types have been developed. In hemiplegia, an orthosis that keeps the shoulder abduction with the help of axillary support is recommended.

Due to the advantages and disadvantages of the shoulder strap, its use in stroke patients is controversial in the literature. Short-term use of the shoulder strap to support the flaccid extremity during selected activities, such as gait training and transfer, may be beneficial. Still, the shoulder strap should not be used in the supine position. The use of shoulder straps should also be minimized during rehabilitation.

Advantages of Using a Shoulder Strap

  • Supports the weight of the arm

  • Prevents soft tissue stretching

  • It can reduce pressure on neurovascular structures

  • Prevents shoulder damage during transfer and walking training

Disadvantages of Using a Shoulder Strap

  • Prevents spontaneous use of the upper extremity

  • Postural support in the upright position may hinder arm functions, such as carrying.

  • Prevents reciprocal arm swing during walking

  • It only brings the humeral head closer to the scapula without affecting the alignment of the scapula and trunk and does not reduce the amount of subluxation.

  • This may contribute to neglect syndrome and learned disuse.

  • May initiate the development of shoulder-hand syndrome due to immobility.

  • It can cause the upper extremity to be in a shortened position.

  • It may cause shoulder pain in the patient by shortening the internal rotators.