Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1137, USA.
J Hand Ther. 2013 Apr-Jun;26(2):139-46; quiz 147. doi: 10.1016/j.jht.2012.10.001. Epub 2012 Nov 11.
Case series design on a single subgroup of participants.
Management of hypertonicity and resistance to passive movement (RTPM) in the upper extremity is an intractable problem for persons with stroke and the therapists who provide their care. Therapists have limited options for assessment and treatment of this condition which can profoundly limit functional performance and quality of life.
To evaluate the effect of a 12-week dynamic progressive orthotic intervention in persons with chronic stroke exhibiting wrist flexion contracture who are residents of a long-term skilled nursing facility.
A custom-fitted dynamic progressive wrist extension orthotic was applied to 6 residents with chronic stroke. The orthotic was worn for 4 h daily, 4×/week for 12 weeks. Wrist passive range of motion (PROM) and RTPM were measured weekly and after discontinuation of the orthotics using the Modified Ashworth Scale and the Tardieu Scale of Spasticity. Signal analysis of electromyographical (EMG) flexor response to extensor stretching was also measured before and after orthotic intervention using maximal root mean square (RMS) values and EMG burst onset time.
A moderate effect was found for changes in PROM with the orthotic intervention. Progress made diminished following discontinuation. Moderate effects were also seen in EMG measures which indicated increases in amount of resistive-free movement following intervention.
A dynamic progressive orthotic intervention can be an effective option for increasing wrist PROM and reducing RTPM in persons with chronic stroke.
单一组别参与者的病例系列设计。
上肢张力过高和抵抗被动运动（RTPM）的管理对中风患者和为其提供护理的治疗师来说是一个棘手的问题。治疗师在评估和治疗这种情况的选择有限，这可能会严重限制其功能表现和生活质量。
评估为期 12 周的动态渐进式矫形器干预对患有慢性中风、腕部屈肌挛缩且居住在长期护理设施中的患者的效果。
为 6 名患有慢性中风的患者定制了动态渐进式腕部伸展矫形器。矫形器每天佩戴 4 小时，每周佩戴 4 天，持续 12 周。每周测量腕部被动活动度（PROM）和 RTPM，在停止使用矫形器后使用改良 Ashworth 量表和痉挛性 Tardieu 量表进行测量。使用最大均方根（RMS）值和肌电图爆发起始时间，在矫形器干预前后还测量了屈肌对伸肌拉伸的肌电图（EMG）反应的信号分析。
在矫形器干预下，PROM 的变化显示出中等效果。停止干预后，进展速度减慢。EMG 测量也显示出中等效果，表明干预后抵抗自由运动的幅度增加。
动态渐进式矫形器干预可能是增加慢性中风患者腕部 PROM 和减少 RTPM 的有效选择。
4。
