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Dynamic Splints and Contracture: What You Need to Know

Saebo
Sunday, May 5th, 2019


Surviving a stroke is a debilitating and frightening experience, and survivors are often affected for an extended period of time after suffering a stroke event. During their stroke recovery period, among other complications and conditions, many survivors can  experience spasticity and contractures in the hand. Spasticity and contractures can cause a painful and, sometimes, permanently clenched hand. This post will describe the conditions of spasticity and contractures, answering many of the frequently asked questions on how to treat these conditions with use of orthotics and splinting. So what is spasticity? Let’s take a look…

What Is Spasticity?

Following a stroke event, survivors may experience an unusual tightening of the muscles in and around the hand on the weaker side of the body. Muscle movements are controlled by a complex system that allows some muscles to contract (tighten), while others relax. Damage to the brain in conditions such as a stroke or traumatic brain injury can disrupt this pattern, causing tightness.This involuntary muscular tightness is referred to as spasticity. When spasticity is present, certain muscles are continuously contracted. Studies show that 20 to 30 percent of stroke survivors experience this condition.  If left untreated, spasticity can cause a survivor’s joints and muscles to become so tight that it is impossible to move them, a precursor to contracture, interfering with normal movement and function.

Image of post-stroke contracture in a 42 year old patient.

What is Contracture?

The simplest way to define contracture is as the loss of motion over time due to abnormal shortening of the soft tissue structures spanning one or more joints. Hand contracture is marked by the muscles in the hand and wrist tightening and shrinking, which often leads to rigidity and deformity of the joints. Besides stroke and traumatic brain injury, other common causes of hand contractures include burns, cerebral palsy, nerve damage and muscular dystrophy.

How Does Contracture Progress?

Contracture can progress rapidly. The initial shortening of muscles and tissue can begin within hours or days of a stroke. As the tightening advances, survivors can lose more mobility within the joint. Even small everyday tasks like eating and dressing become increasingly difficult.

The symptoms of contracture vary depending on the severity of the case. There are four stages of contracture symptoms, which progress over time from Stage I to Stage IV. Unfortunately, contracture often goes undiagnosed until Stage III.

The Four Stages of Contracture

  • Stage I contractures can develop within a week after a stroke event. Sometimes, Stage I contractures occur as quickly as the first four days.
  • Stage II takes another seven to fourteen days to develop.
  • Stage III requires up to a year and a half (around 500 days) in recovery time.
  • Stage IV is when a patient’s muscles and joints have stiffened so much that they have folded into a fetal position.

What Can Be Done?

An occupational or physical therapist’s efforts are critical in helping survivors understand the challenges of stroke and correctly treat any complications during recovery. In the past and present, therapists have approached contracture treatment through the use of static hand splints. A simple way to define “splint” is a rigid material or apparatus used to support and immobilize a broken or impaired bone, joint or tissue. What purpose does a splint serve in the case of stroke? It is theorized that, in the case of contracture, splints provide necessary stretch to affected soft tissue in the hand to prevent deformities, however, recent studies suggest that static splints are  ineffective and may cause unnecessary harm. In fact, static hand splinting does not prevent contracture and, over time, a static splint may actually lead to joint damage. Today, it is widely believed that static devices lack established, evidence-based support for their continued use.

 

What occupational therapists are finding is that dynamic splinting is very effective and can even help treat the side effects caused by static splints, such as joint damage and hypermobility. Dynamic hand splints like the SaeboStretch, improve range of motion and address contracture pain. Compared with static splints, a dynamic extension splint allows for more mobility throughout recovery, while still providing much-needed support and stability to the affected area.

The SaeboStretch splint uses a revolutionary technology that allows the fingers and joints to move through flexion. This helps the fingers relax, which in turn gradually returns the fingers to their natural position. The SaeboStretch in particular is highly beneficial for neurologically impaired clients, especially with improving mobility and minimizing joint pain and damage. It is made with energy-storing technology, which allows patients suffering from spasticity and contractures to safely stretch their tight muscles and joints. This results in a greater range of motion and compliance in the affected areas. It’s recommended that the patients perform a low-load, prolonged stretch for 6 to 12 hours daily which is attainable through the use of a proper dynamic orthosis.  

The SaeboFlex gives people the ability to perform grasp-and-release activities, which allows them to participate in task-oriented hand training. Evidence-based research supports this training as critical to recovery. The SaeboFlex is appropriate for individuals with minimal to severe spasticity.The SaeboFlex is a high-profile orthosis with an outrigger system that covers the back of the hand, fingertips, and forearm. This orthosis positions the wrist and fingers into extension to prepare them for grasp and release exercises. With the assistance of the SaeboFlex, the user is able to grasp objects by voluntarily flexing his or her fingers. Once the fingers relax (stop gripping), the extension spring system assists in re-opening the hand to release the object.

Range-of-Motion Exercises

Soft tissue that has been shortened due to a stroke can be lengthened over time with dedicated stretching and range-of-motion techniques. Range-of-motion exercises are an effective way to reverse and prevent contracture; they stimulate the muscles and joints, create more blood flow to the affected area, and reduce the risk of blood clots.

The Most Important Thing to Know about Contractures Is That You Can Prevent it!

It’s safe to say that stroke survivors face many challenges. Occupational and physical therapists are a crucial component to treating patients in stroke recovery and can help mitigate the complications that arise from a stroke and make the recuperation process much easier on stroke survivors.

Survivors, caregivers, and rehabilitation team members must maintain a robust knowledge of the different ways to prevent and treat contracture. Here at Saebo, we are committed to stroke support and recovery for all survivors and their families. Saebo offers a wide range of products that combine cutting-edge technology with evidence-based rehabilitation techniques. Our offerings and network of Saebo-trained therapists can help you or a loved one to obtain all the necessary tools to maximize stroke recovery.


All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.



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