Archives of physical medicine and rehabilitation · 2005
Application of a volar static splint in poststroke spasticity of the upper limb.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Pizzi Assunta, Carlucci Giovanna, Falsini Catuscia, Verdesca Sonia, Grippo Antonello
Аннотация
OBJECTIVE: To evaluate clinical and neurophysiologic effects of 3-month reflex inhibitory splinting (RIS) for poststroke upper-limb spasticity.
DESIGN: Pretest-posttest trial.
SETTING: Outpatient rehabilitation center.
PARTICIPANTS: Forty consecutive patients with hemiplegia and upper-limb spasticity after stroke that had occurred at least 4 months before.
INTERVENTION: Patients wore an immobilizing hand splint custom-fitted in the functional position for at least 90 minutes daily for 3 months.
MAIN OUTCOMES MEASURES: Patients underwent measurement of (1) spasticity at the elbow and wrist according to Modified Ashworth Scale; (2) passive range of motion (PROM) at the wrist and elbow; (3) pain at the shoulder, elbow, and wrist using a visual analog scale; (4) spasms; and (5) comfort and time of splint application. The instrumental measure of spasticity was the ratio between the maximum amplitude of the H-reflex and the maximum amplitude of the M response (Hmax/Mmax ratio).
RESULTS: A significant improvement of wrist PROM (F=8.92, P=.001) with greater changes in extension than in flexion, and a reduction of elbow spasticity (F=5.39, P=.002), wrist pain (F=2.89, P=.04), and spasms (F=4.33, P=.008) were observed. The flexor carpi radialis Hmax/Mmax ratio decreased significantly (F=4.2, P=.007). RIS was well tolerated.
CONCLUSIONS: RIS may be used as an integrative treatment of poststroke upper-limb spasticity. It can be used comfortably at home, in selected patients without functional hand movements, and in cases of poor response or tolerance to antispastic drugs.
DESIGN: Pretest-posttest trial.
SETTING: Outpatient rehabilitation center.
PARTICIPANTS: Forty consecutive patients with hemiplegia and upper-limb spasticity after stroke that had occurred at least 4 months before.
INTERVENTION: Patients wore an immobilizing hand splint custom-fitted in the functional position for at least 90 minutes daily for 3 months.
MAIN OUTCOMES MEASURES: Patients underwent measurement of (1) spasticity at the elbow and wrist according to Modified Ashworth Scale; (2) passive range of motion (PROM) at the wrist and elbow; (3) pain at the shoulder, elbow, and wrist using a visual analog scale; (4) spasms; and (5) comfort and time of splint application. The instrumental measure of spasticity was the ratio between the maximum amplitude of the H-reflex and the maximum amplitude of the M response (Hmax/Mmax ratio).
RESULTS: A significant improvement of wrist PROM (F=8.92, P=.001) with greater changes in extension than in flexion, and a reduction of elbow spasticity (F=5.39, P=.002), wrist pain (F=2.89, P=.04), and spasms (F=4.33, P=.008) were observed. The flexor carpi radialis Hmax/Mmax ratio decreased significantly (F=4.2, P=.007). RIS was well tolerated.
CONCLUSIONS: RIS may be used as an integrative treatment of poststroke upper-limb spasticity. It can be used comfortably at home, in selected patients without functional hand movements, and in cases of poor response or tolerance to antispastic drugs.
Предметные рубрики MeSH
AdultAgedAnalysis of VarianceFemaleH-ReflexHemiplegiaHumansMaleMiddle AgedMuscle ContractionMuscle RelaxationMuscle SpasticityMuscle, SkeletalPhysical Therapy ModalitiesProbabilityPrognosisProspective StudiesRange of Motion, ArticularRisk AssessmentSeverity of Illness IndexSplintsStrokeStroke RehabilitationTreatment OutcomeUpper Extremity