Effect of hand splinting versus stretching exercises for reducing spasticity and improving hand function in poststroke hemiplegia: A comparative interventional study

Abstract

Background: Hand splints are used to prevent muscular hyperactivity in adult poststroke patients. Reflex inhibitory splints may be used as an integrative treatment of poststroke upperlimb spasticity. Hand splints are used by occupational therapists as a method of reducing the increased muscle tone of the upper extremity following stroke. Muscle stretching is becoming a very common practice in the rehabilitative management of spasticity. It includes several types of muscle stretching such as passive stretching, active stretching and prolonged stretching, isotonic stretching, and isokinetic stretching. Objectives: The objective of this study was to study the difference between the effects of splinting and stretching in reducing spasticity and improving hand function in poststroke hemiplegia. Study Design: This was a two-arm comparative interventional study. Methods: A total of 30 poststroke hemiplegic patients fulfilling the inclusion criteria which mainly include patients having tone of the affected upper extremity at wrist and fingers ≥2, according to the Modified Modified Ashworth Scale (MMAS), having score ≥25 on Mini-Mental State Examination and having age between the age group of 35 and 65 years are enrolled for the study. Consecutive sampling was done by putting all odd number patients in the splinting group and all even number patients in the stretching group. Assessment tools and outcome measures were B and C subscales of Fugl-Meyer Assessment of Physical Performance for Upper Extremity and MMAS. The patients of the splinting group were given a resting hand splint to wear for 10–12 h continuously per day for 6 weeks. Stretching exercise using a prolonged slow stretch technique was carried out to patients of the stretching group. Results: The patients of splinting group showed more improvement in spasticity and hand function than stretching group with mean difference of 1, P= 0.695, and 95% confidence interval (CI) = −26.41–−22.39 for wrist flexor spasticity, for finger flexor spasticity mean difference was 4, P= 0.143, and 95% CI = −8.28–−5.42 and for hand function mean difference was 4, P= 0.13, and 95% CI = 14.62–20.47. Conclusion: There was the statistically nonsignificant difference between the efficacy of hand splinting and stretching exercises, in reducing spasticity and improving hand functions in poststroke hemiplegia. However, clinically, hand splinting is more beneficial than stretching exercises for the desired outcomes.