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| Rebecca Dutton Home After a Stroke |
Studies of resting hand splints make me cringe when researchers ask the wrong questions. Studies done by Lannin (1) and Burge (2) asked if resting hand splints improve functional hand use. Lannin's test subjects were asked to draw with their hemiplegic (paralyzed) hand and then were given a splint. Did these subjects jump to the conclusion that hand splints work miracles?
A resting splint that places the hand in one static position does not retrain the brain. So it is not surprising that Lannin (1) and Burge (2) found resting hand splints produced no significant improvement on hand function tests, like the Motor Assessment Scale.
Lannin (1) also concluded "splinting has little or no effect on the loss of range of motion" (p. 113) because subjects who did and did not wear a resting splint lost some wrist range of motion (ROM). Unfortunately, Lannin told therapists who were treating subjects with a resting night splint to stop all passive stretching and restrict active hand exercises to 10 minutes a day. This is like telling people to stop taking aspirin to bring down their fever while they are taking an antibiotic.
I asked a different question. What would happen if I continue to do passive stretching and active hand exercises, but stop wearing my resting splint at night? After a month of not wearing my resting splint it felt like my thumb was getting tighter. I resumed wearing my resting splint and the next morning I woke up with a ferocious ache in my thumb.
A study by Burge confirmed my personal experience. Eight of his subjects who did not wear a resting splint lost ROM while no one who wore a splint lost ROM (2). However, this group difference did not achieve a probability value (P) of 0.10 or less. Burge's P value of 0.128 was
not statistically significant, but the difference between the two groups suggests Lannin's conclusion that splints do not affect ROM is premature.
When I was a young therapist, degrees of ROM were numbers I wrote in a client's chart. As a client a loss of ROM is terrifying because spasticity that gets out of control hurts. Botox shots hurt because a doctor uses the end of the needle to dig around in the muscle to find the best spot. Only surgery can reverse contractures created by permanent shortening of a spastic muscle.
I do not want these bad things to happen to me. While I wait for more studies on resting splints the potential consequences are too severe. That is why I wear my night splint even when I travel.
- Lannin, N, Cusick, A, McCluskey, A, Herbert, R. Effects of splinting on wrist contracture after stroke. Stroke. 2009;38:111-116.
- Burge E, Kupper D, Finckh A, Ryerson, S, Schnider A, Leemann B. Neutral functional realignment orthosis prevents hand pain in patients acute stroke: A randomized trial. Archives of Physical Medicine and Rehabilitation. 2008;89(10):1857-1862.
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