Effect of Paddle static splint on muscle tone, range of motion, and dexterity of upper-extremity in children with spastic hemiplegia

Document Type : Original article

Authors

1 MSc in Occupational Therapy

2 Assistant Professor of Iran University of Medical Sciences(IUMS). School of Rehabilitation

3 Candidate of PhD Occupational Therapy. School of Rehabilitation, Iran University of Medical Sciences (IUMS), Tehran, Iran.

4 4. Candidate of PhD Neuroscience. School of Rehabilitation, Iran University of Medical Sciences (IUMS), Tehran, Iran.

Abstract

Background and Aims: The most common type of cerebral palsy is spastic hemiplegia, which can lead to functional limitations, especially in the upper limbs. The proposed rehabilitation method in the treatment of this group of children is using splints to improving range of motion, adjusting tone, and improving hand function. The aim of the present study was to assess the effect of Paddle splint in range of motion, tone, and dexterity of upper extremity spastic hemiplegia in 5-11 year-old children with.
Materials and Methods: The current study followed a randomized clinical trial, double-blind, and parallel design using paddles static splint in two groups on 30 5-11 year-old children with spastic hemiplegia. The control group used routine occupational therapy programs (Neuro-Developmental Treatment) and the intervention group, in addition to the routine treatment interventions, used Paddle splint for two months (4 hours daily and 4-6 hours at night). The assessments in the affected side included evaluation of tone using Modified Ashworth Scale (MAS), active and passive range of motion of wrist, Purdue-Pegboard and Box-Block tests to assess fine and gross hand dexterity before and two months after the treatment was administered.
Results: The results showed a significant difference in gross hand function using box and block test (p=0.001), active wrist range of motion (p=0.005), and spasticity of wrist and elbow flexors muscles in intervention group compared with those in the control group. The data did not show any significant difference in passive wrist range of motion (p=0.14) and fine hand dexterity using Purdue Pegboard test (p=0.18) between the two groups.
Conclusion: The results of the present study indicate that using splints paddles with Neuro-Developmental Treatment approach can improve the gross hand dexterity and active wrist extension range of motion and reduce spasticity in the flexor muscles of the wrist and elbow effective.

Keywords

Main Subjects

References

  1. Burtner PA, Poole JL, Torres T, Medora AM, Abeyta R, Krrne J, et al. Effects of wrist hand splints on grip, pinch, manual dexterity and muscle activation in children with spastic hemiplegic: A preliminary study. J Hand Ther. 2008; 21(1): 36-42.##
  2. Sajedi F, Togh M, Karimzadeh P. A survey on 200 cases of cerebral palsy in Welfare and Rehabilitation centers of Tehran. ITJ. 2011; 3(2): 161-72.##
  3. Cans C, De-la-cruz J, Mermet MA. Epidemiology of cerebral palsy. Pediatrics and Health. 2008; 18(9): 393-8.##
  4. Waters PM and Van heest A. Spastic hemiplegia of the upper extremity. Hand Clin. 1998; 14(1): 119-34.##
  5. Beckung E, Hagburn G. Neuro impairments, activity limitations, participation restrictions in children with cerebral palsy. Dev Med Child Neurol. 2002; 44(2): 309-16.##
  6. Adams BD, Grosland NM, Murphy DM, McCullough M. Impact of impaired wrist motion on hand and upper extremity performance. J Hand Surg Am. 2003; 28(6): 898–903.##
  7. Wesdock KA, Kott K, Sharps C. Pre and post-surgical evaluation of hand function in hemiplegic cerebral palsy. J Hand Ther. 2008; 2(1): 386-97.##
  8. Fedrizzi E, Pagliano E, Andreucci E, Oleari G. Hand function in hemiplegic cerebral palsy: Prospective follow up and functional outcome in adolescence. Dev Med child neurol. 2003; 45(2): 85-91.##
  9. Carmick C. Use of neuromuscular electrical stimulation and a dorsal wrist splint to improve the hand function of a child with spastic hemiparesis. Phys Ther. 1997; 77: 661-71.##
  10. Barnes MP, Johnson OR. Overview of clinical management of spasticity in upper motor neuron syndrome and spasticity: Clinical management and neuro-physiology. Cambridge University Press: 2001. P. 444##
  11. Burtner PA, Anderson JB, Marcum ML, Poole JL, Qualls C, Picchiarini MS. A comparison of static and dynamic wrist splints using electromyography in individuals with rheumatoid arthritis. J Hand Ther, 2003, 16(4): 320-5.##
  12. Katalinic OM, Harvey LA, Herbert RD, Moseley AM, Lannin NA, Schurr K. Stretch for the treatment and prevention of contractures. Cochrane Database Syst Rev 2010; 8(9): CD007455##
  13. Pizzi A, Carlucci G, Falsini C, Verdesca S, Grippo A. Application of a volar static splint in poststroke spasticity of the upper limb. Arch Phys Med Rehabil. 2005; 86(9): 1855-9.##
  14. Abdolvahab M, Bagheri H, Giovani Gh, Olyaei GH, Galilei M, Baghestani A. The effect of palmar static splint on hand function, muscle tone, range of motion elbow and hand in 8-12 years old cerebral palsy spastic J Modern Rehabil. 2011; 5(1): 31-6. [In Persian]##
  15. Abdolvahab M, Bagheri H, Mahdizadeh H, Olyaei GH, Galilei M, Faghihzadeh S. Effects of volar static splint on function and spasticity of upper extremity of hemiplegic adults. J Med Council IRI. 2010; 28(1): 9-18. [In Persian]##
  16. Gill DR; Smith KL; Harvey FJ. Plaster of Paris splint age for the hand: volar or dorsal? The Aust New-Zealand J Surg. 1994; 64(8): 547-50.##
  17. Abdolvahab M, Bagheri H, Daliri A, Olyaei GH, Galilei M, Faghihzadeh S. The effect of special two different types of splint, volar and dorsal, on reduction of spasticity of hand in spastic cerebral palsy 4-6 years old. J Modern Rehabil. 2008; 2: 46-50. [In Persian]##
  18. Sharifi N, Abdolvahab M, H-Mehraban A, Azad A, Galilei M, Baghestani A. The effect of C-bar splint on hand function in 8-12 years old spastic diplegic children. J Modern Rehabil. 2014; 2: 22-8. [In Persian]##
  19. Fallahzadeh-Ab A, Abdolvahab M, H-Mehraban A, Aliabadi F, Galilei M, Baghestani A. The effects of static cock up c-bar splint on strength, spasticity, range of motion, and dominant hand function in spastic diplegic children. J Modern Rehabil. 2013; 6(4): 15-23. [In Persian]##
  20. Vaz DV, Mancini MC, Fonseca ST, Vieira DS, Pertence AE. Muscle stiffness and strength and their relation to hand function in children with hemiplegic cerebral palsy. Dev Med child neurol. 2006; 48(9): 728–33.##
  21. Amini M, Moosavi S, Shamily A, Kazemi R, Qorbani M, Pashmdarfard M. Impact of extension splint on function of upper extremity in chronic stroke patients. Iranian Rehabil J. 2014; 12(19): 18-21.##
  22. Nakhostin-Ansari N, Naghdi1 S, Forogh B, Hasson S, Atashband M, Lashgari E. Development of the Persian version of the Modified Ashworth Scale: Translation, adaptation, and examination of inter-rater and intra-rater reliability in patients with poststroke elbow flexor spasticity. Disabil Rehabil. 2012; 34(21): 1843–7.##
  23. Buddenberg LA, Davis C. Test-retest reliability of the Purdue Pegboard test. Am J Occupa The. 2000; 54(5): 555-8.##
  24. Costa LD, Vaughan HG, Levita E, Farber N. Purdue Pegboard as a predictor of the presence and laterality of cerebral lesions. J Consult Psychol. 1963; 27(2): 133-7.##
  25. Lin KC, Chuang LL, Wu, CY, Hsieh YW, Chang WY. Responsiveness and validity of three dexterous function measures in stroke rehabilitation. J Rehabil Res Dev. 2010; 47(6): 563-71.##
  26. Smith J, O’Brien JC. Occupational therapy for children.6 ed. Missouri: Mosby. 2010. P. 278.##
  27. Irani A, Imani A, Rezasoltani A, Hosseini SA. The effect of using of an anti-spastic orthosis on the gross motor function in diplegic spastic children in Tehran. J Rehab Med. 2014; 3(3): 34-42. [In Persian]##
  28. Postans N, Bromwich W, Wright PA, Wilkinson I, Farmer SE, Swain ID. The combined effect of dynamic splinting and Neuro muscular electrical stimulation in reducing wrist and elbow contractures in six children with cerebral palsy: A Pilot Study. Pros Ortho Inter J. 2010; 34(1): 10-19.##
  29. Fujiwara T, Liu M, Hase K, Tanaka N, Hara Y. Electrophysiological and clinical assessment of a simple–wrist hand splint for patients with chronic spastic hemiparesis secondary to stroke. Electromyogr Clin Rehabil. 2004; 44(7): 423–9.##
  30. Copley J, Watson-Will A, Dent K. Upper limb casting for clients with cerebral palsy: A clinical report. Aus Occupa Thera J. 1996; 43: 36-50.##
  31. Gracies JM, Marosszeky JE, Renton R, Sandanam J, Gandevia SC, Burke D. Short-item effect of dynamic Lycra splint on upper limb in hemiplegic patients. Arch Phys Med Rehabil. 2000; 81: 1547-55. ##
  32. Mills VM. Electromyography results of in inhibitory splint. Phys Ther. 1984; 64: 190-3.##
  33. Marque P, Pierrot-Deseilligny E, Simonetta-Moreau M. Evidence for excitation of the human lower limb Moto neurons by group II muscles afferents. Exp Brain Res. 1996; 109: 357-60.##
  34. Simonetta-Moreau M, Marque P, Mrchard-pauvert V, Pierrot-Deseilligny E. The pattern of excitation of human lower limb motor neurons by probable group II muscle afferents. J Physiol. 1999; 517: 287-300.##
The Scientific Journal of Rehabilitation Medicine
Volume 5, Issue 1
March and April 2016
Pages 174-182

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History

  • Receive Date: 09 June 2015
  • Revise Date: 01 August 2015
  • Accept Date: 08 April 2016
  • First Publish Date: 08 April 2016

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