Splinting the flaccid hand in the acute phase

Question: What is your opinion regarding splinting the flaccid hand in the acute phase post-stroke. Is it advisable to prevent spasticity of the intrinsics or would it be better to wait until the subacute stage to splint?

Any thoughts on this would be appreciated.

Answer: Interestingly enough, current research has shown that splinting in stroke patients is not effective at preventing contractures or decreasing spasticity. This is rather odd since splinting has shown to increase mobility and decrease contracture in orthopedic patients, but obviously the causes of orthopedic and neurological conditions are different.

The only times I personally recommend splints to stroke patients are to prevent skin breakdown or if a splint can provide increased function to the hand (e.g. allows positioning of the hand so that the patient can grasp better or assists patient in release, etc.) If a patient comes to me and already has a night splint that they wear, and they feel it helps, I tell them to go ahead and wear it if they want (after I inspect it to make sure it won't cause any damage to the hand). I always encourage my patients not to wear any such splints in the day though as I want them working on trying to regain movement.

To explore the research results of splinting the upper extremity after stroke, I recommend reading http://www.ebrsr.com/sites/default/files/module-10-upper-extremity_final_16ed.pdf and http://content.iospress.com/articles/neurorehabilitation/nre00629.

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