Neuromuscular electrical stimulation and dynamic bracing as a treatment for upper-extremity spasticity in children with cerebral palsy.

We have investigated a therapeutic regimen using neuromuscular electrical stimulation (NMES) and dynamic bracing to assess their effectiveness in reducing upper-extremity spasticity in children with cerebral palsy. Nineteen patients between 4 and 21 years of age with documented diagnoses of spastic cerebral palsy were treated. The patients included in the study followed a regimen of two 30-minute sessions of NMES of the antagonist extensors combined with dynamic orthotic traction during the day. A static brace was used at night. Spasticity of the wrist and fingers was assessed periodically using the Zancolli classification. Treatment ranged from 3 to 43 months. After treatment with electrical stimulation and dynamic bracing, all the patients moved up 1 to 3 levels in the Zancolli classification and showed a marked improvement in upper-extremity function. These results show that combining NMES and dynamic orthotic traction dramatically decreases spasticity of the upper extremity in young patients with cerebral palsy.

Functional results of dynamic splinting after transmetacarpal, wrist, and distal forearm replantation.

The results of replantation at the wrist and distal forearm are reported to be better than at the metacarpal level, in part because the latter involve direct injury to the intrinsic muscles. This study evaluates a new post-operative protocol for replantation at the metacarpal, wrist and distal forearm levels. 3 days after replantation, the patient was placed in a dynamic crane outrigger splint with MP joint control, compensating for intrinsic muscle function loss. From 4 to 12 weeks, an anticlaw splint alternated with the outrigger splint. After 12 weeks, a dynamic wrist extension orthosis was added to the anti-claw splint. 11 patients (four replantations at the transmetacarpal level, three at the wrist and four in the distal forearm) had this protocol between 1988 and 1993. For distal forearm replantation, TAM of fingers averaged 216 degrees, grip strength 42 lb, and pinch strength 7.2 lb with 75% good or excellent results. For wrist replantations, TAM of fingers averaged 243 degrees, grip strength 37 lb and pinch strength 10.6 lb with 100% good or excellent results. For transmetacarpal replantations, TAM of fingers averaged 189 degrees, grip strength 37 lb and pinch strength 5.6 lb, with 75% good and excellent results. Early protected mobilization, as described here, preserves tendon gliding, muscle strength and excursion. Our results support this protocol for wrist and distal forearm replantation and especially for transmetacarpal replantation, the results of which tend to be poor according to the medical literature.

A new dynamic splint for postoperative treatment of flexor tendon injury.

This dynamic splint lessens resistance to finger extension and increases the arc of motion through full passive flexion of the injured fingers. Rubber bands run from the tips of the injured fingers under a spring-loaded roller bar at the metacarpophalangeal joint level to a coiled lever at the distal flexor surface of the forearm. The wrist is positioned in 45 degrees of flexion with 40 degrees to full flexion of the metacarpophalangeal joints and full flexion to full extension of the interphalangeal joints. We retrospectively compared patients treated in the new and traditional splints. Patients with coexisting fractures, extensor tendon injury, and insufficient follow-up were excluded. By use of Strickland's modified criteria in evaluating 36 patients treated in the new splint, 35 of 46 fingers with zone II tendon injury (76.1%) had excellent and 11 (23.9%) had good total active motion; none had fair or poor results or ruptures. Results were significantly better than after treatment in the traditional splint.

Adjustable dynamic external splint for control of first web contracture.

A method is presented to overcome problems of first web space contracture by means of a dynamic, continuously adjustable, wedge-shaped splint. The device is easily constructed of inexpensive material by physician or hand therapist. The splint is custom-tailored to the individual patient and is lightweight and comfortable, promoting good patient compliance. Its continuously adjustable nature maximizes its effects throughout therapy, and the even distribution of the pressure makes for a high surface area of patient/splint contact for even pressure distribution and eliminates the problems of skin necrosis, even with lengthy applications.