Splinting the hand in the functional position after brain impairment: A randomized, controlled trial

Abstract

Lannin NA, Horsley SA, Herbert R, McCluskey A, Cusick A. Splinting the hand in the functional position after brain impairment: a randomized, controlled trial. Arch Phys Med Rehabil 2003;84:297-302. Objective: To evaluate the effects of 4 weeks of hand splinting on the length of finger and wrist flexor muscles, hand function, and pain in people with acquired brain impairment. Design: Randomized, assessor-blinded trial. Setting: Rehabilitation center in Australia. Participants: Twenty-eight adults with acquired brain impairment, all within 6 months of the first injury. There was 1 withdrawal. Interventions: Subjects in both experimental (n=17) and control (n=11) groups participated in routine therapy[mdash ]motor training for upper-limb use and upper-limb stretches[mdash ]5 days a week. The experimental group also wore an immobilizing hand splint in the functional position (10[deg ][ndash ]30[deg ] wrist extension) for a maximum of 12 hours each night for the duration of the 4-week intervention period. Main Outcome Measures: The length of the wrist and extrinsic finger flexor muscles was evaluated by measuring the torque-controlled range of wrist extension with the fingers extended. Functional hand use was evaluated with the Motor Assessment Scale. Pain was evaluated with a visual analog scale. Results: The effects of splinting were statistically nonsignificant and clinically unimportant. At follow-up, estimates of treatment effects slightly favored the control group: range of motion at the wrist favored controls by 2[deg ] (95% confidence interval [CI], [minus ]7.2[deg ] to 3.2[deg ]), function favored controls by 0.2 points (95% CI, [minus ]2.7 to 2.3), and pain favored the experimental group by 1cm (95% CI, [minus ]4.6 to 2.2). Conclusions: An overnight splint-wearing regimen with the affected hand in the functional position does not produce clinically beneficial effects in adults with acquired brain impairment. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation