**5.3 Wrist and hand**

Contracture improvement [2, 40]:

• Using splints for deformity correction in hand and wrists is not routinely advised for every patient (e.g., in stroke and acute brain injury patients). However, they can be used in certain cases in an optional way (2B). These splints are custom-made or serial and adjustable (10 degrees wrist extension and finger extension with MCP flexion, wrist at neutral, or maximal available range of movement). Most of them are used for 20 minutes to 12 hours a day for a 1- to 8-week period.

Contracture prevention [2, 40]:

• Using splints for deformity prevention in hand and wrists is not routinely advised for every patient (e.g., in stroke and acute brain injury patients). However, they can be used in certain cases in an optional way (2B). In the studies, the splints have been used in different positions (10 degrees wrist extension and fingers fully extended, wrist at neutral, or close to maximal available range of movement) with duration of 6–12 hours a day for a 1- to 8 week period.

• The use of C-Bar splint is an effective method to improve hand performance and range of motion while decreasing spasticity in upper limb of cerebral palsy

• Using anti-pronation splints can be an effective technique to improve the performance of upper limb, range of motion of forearm supination, and wrist extension, as well as reducing the severity of spasticity in forearms pronator muscles and wrist flexor muscles. These splints are also effective in improving the gripping and pinching ability in children suffering from spastic diplegia

• Extension splints are not helpful in the rehabilitation program of stroke

• As a modern splint, SAEBO splints can be helpful in improving the upper limb

• In general, volar, dorsal, anti-pronation, and C-Bar splints are effective in spasticity reduction and performance improvement of upper limb in children

with cerebral palsy while SAEBO and dynamic splints are useful for performance improvement and spasticity reduction of upper limb.

• Using casts is recommended at the end of range of motion to modify the

• Short-term application of the cast (1–4 days) entails fewer complications

• Enough studies for contracture correction by splint are not available.

elbow's range of motion (2C). The cast should be replaced every 3–7 days. Use

children.

*sheepskin palm protector is used to prevent tissue damage.*

*Rehabilitation Medicine Management of Spasticity DOI: http://dx.doi.org/10.5772/intechopen.93008*

**Figure 2.**

cerebral palsy.

of stroke patients.

Contracture improvement [40, 42]:

the cast for a 1- to 4-week period.

compared to the longer use (4–7 days) (2C).

patients.

**5.4 Elbow**

**99**


Performance improvement [2, 42]:


*Rehabilitation Medicine Management of Spasticity DOI: http://dx.doi.org/10.5772/intechopen.93008*

**5.3 Wrist and hand**

Contracture improvement [2, 40]:

for a 1- to 8-week period.

week period.

patients (2B).

Contracture prevention [2, 40]:

for contracture prevention (2A).

6 hours a day for 13 weeks.

spasticity reduction.

**98**

Performance improvement [2, 42]:

tissue damage (e.g., sheepskin palm protector).

performance of upper limb in stroke patients.

• Using splints for deformity correction in hand and wrists is not routinely advised for every patient (e.g., in stroke and acute brain injury patients). However, they can be used in certain cases in an optional way (2B). These splints are custom-made or serial and adjustable (10 degrees wrist extension and finger extension with MCP flexion, wrist at neutral, or maximal available range of movement). Most of them are used for 20 minutes to 12 hours a day

*Neurostimulation and Neuromodulation in Contemporary Therapeutic Practice*

• Using splints for deformity prevention in hand and wrists is not routinely advised for every patient (e.g., in stroke and acute brain injury patients). However, they can be used in certain cases in an optional way (2B). In the studies, the splints have been used in different positions (10 degrees wrist extension and fingers fully extended, wrist at neutral, or close to maximal available range of movement) with duration of 6–12 hours a day for a 1- to 8-

• Using splints in combination with botulinum toxin in selected cases can be effective in reducing the spasticity that has resulted in range of motion loss (2C). The splint is used at the end of the available range of movement but is not adjusted daily. On the other hand, strapping is used at the end of available range of movement, with daily adjustment to maximal stretch for 6 days.

• Using electrical stimulation in combination with splints is not recommended

• Custom-made hand and wrist splints should not be used routinely for prevention from spasticity exacerbation in acute brain injury and stroke

• A wrist splint at neutral position can be effective in hand pain prevention caused by joint malalignment (2A). These splints should be used for minimum

• Sometimes, a splint is also used to improve performance (**Figure 2**) or prevent

• Using volar splints in children with cerebral palsy can reduce the spasticity and improve the range of motion and performance in upper limb. However, theses splints are not effective on the upper limb movements in stroke patients.

• Using dorsal splints has no effect on spasticity, range of motion, and

• Dynamic splints can improve the upper limb performance and accelerate

**Figure 2.** *sheepskin palm protector is used to prevent tissue damage.*

