Algorithms to support the choice of a wrist-hand orthosis for motor function recovery in post-stroke patients: a narrative systematic review.

BACKGROUND

Upper limb paresis and spasticity are predictors of limitations on activities of daily living and decrease in quality of life in post-stroke patients. The French National Authority for Health doesn't recommend the orthosis use; nevertheless, they are commonly used in clinical practice despite the lack of consensus.

OBJECTIVES

To develop algorithms guiding specialists in choosing an orthosis as an adjunct therapy for motor function recovery in post-stroke patients, depending on their recovery stage, paresis impairment and level of spasticity.

METHODS

This is a scoping review, by searching four electronic databases up to August 2023 for reports of controlled trials comparing two different orthoses or an orthosis versus usual rehabilitation.

RESULTS

Twenty-eight studies were included evaluating static, dynamic, electromyography-drive, and/or robotic orthoses. None can be recommended, due to the low power of studies, but some showed positive results. The orthoses evaluated included, in the early subacute stage, the HANDS Therapy or the Gloreha Professional; in the late subacute stage, the NESS handmaster (new noninvasive hybrid neuroprosthesis which has been developed for therapy and restoration of hand function) or a 3D-printed orthosis; in the chronic stage, the TIGER device, a static splint in extension, a robotic hand exoskeleton, a static splint in neutral position post-botulinum toxin type A or a 3D-printed dynamic hand device.

CONCLUSIONS

These are the first algorithms, to our knowledge, to classify wrist-hand orthoses studied for motor function recovery, in adults with an upper limb hemiparesis post stroke. No orthosis can be recommended, but some present promising results.