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Advanced Splinting Concepts

Managing Spacticity. Basmajian defines spasticity as a state of increased muscular tone with exaggeration of the tendon reflexes 1982. Splinting with Spasticity. With moderate to severe spasticity, modification of stretch reflex may be possible by sustained stretchCasting or splinting below full P

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Advanced Splinting Concepts

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    1. Advanced Splinting Concepts

    2. Managing Spacticity

    3. Basmajian defines spasticity as a state of increased muscular tone with exaggeration of the tendon reflexes 1982

    4. Splinting with Spasticity With moderate to severe spasticity, modification of stretch reflex may be possible by sustained stretch Casting or splinting below full PROM at point of activation of stretch reflex is desirable Sustained cutaneous stimulation over skin of spastic muscles believed to inhibit spasticity

    5. If no spasticity at night, splint to reduce contractures Casting is best used to address contractures of wrist and extrinsic finger flexors Splinting to address simple finger or wrist flexor spasticity

    6. Various theories about spasticity splinting Some advocate dorsal splint and some volar Dorsal splint spares palm for sensory input Volar gives better hand arch support avoiding bony prominence

    7. Finger spreaders and Cone splints Finger spreaders - NDT therapists advocate use of reflex inhibiting patterns finger and thumb abduction key point Cone splint Rood advocated inhibition of flexor spasticity by firm cone pressure over palmar surface should not stretch wrist of fingers Does tend to have and inhibitory effect on flexor muscles large end ulnar, small end radial

    13. Soft stimulus increases flexor tone Dayhoff 1975 Soft stimulus may activate primitive grasp reflex Farber 1982 Avoid strapping over palm using soft straps Some studies have demonstrated that sustained gentle stretch reduces the passive component of spasticity McPherson 12981, Mc Pherson et al. 1985, Rose & Shah 1987, Scherling & Johnson 1989 Hand splinted is in position that is < full PROM but > the point of the stretch reflex activation

    14. Air splints Provides stretch and warmth allows therapist to position hand for weight bearing

    15. Dupuytren’s Disease

    18. Silver Ring Splints

    22. QuickCast

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