Lindsey Kerr, OTD, OTR/L, was Occupational Therapy Doctoral Student, Creighton University, Omaha, NE.
Vanessa D. Jewell, PhD, OTR/L, is Assistant Professor and Vice Chair of Research and Assessment, Department of Occupational Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, NE;
Am J Occup Ther. 2020 Sep/Oct;74(5):7405205050p1-7405205050p15. doi: 10.5014/ajot.2020.029454.
Spasticity is one of the most common and disabling motor impairments after stroke.
To examine the evidence for the effectiveness of stretching interventions, including splinting, on reducing upper extremity spasticity, increasing hand function, and improving functional tasks for adults with poststroke spasticity.
Databases searched were MEDLINE, CINAHL, OTseeker, AgeLine, and the Cochrane Library; results were limited to studies published from 2004 to January 2017.
Following PRISMA guidelines, we included articles describing Level I-III studies with participants who were adults with upper extremity spasticity and received a stretching intervention.
Eleven articles describing 6 Level I and 5 Level III studies met inclusion criteria.
For reducing upper extremity spasticity, low strength of evidence was found to support the use of static splinting, strong strength of evidence was found for the use of stretching devices, and low strength of evidence was found to support the use of dynamic splinting; no evidence was found for manual stretching to address spasticity. For increasing hand function, moderate strength of evidence was found to support the use of static splinting, dynamic splinting, and manual stretching, and low strength of evidence was found for the use of stretching devices. For improving functional tasks, moderate strength of evidence was found to support the use of static splinting, dynamic splinting, and manual stretching, and low strength of evidence was found for the use of stretching devices.
This updated synthesis summarizes the current literature regarding the effectiveness of stretching interventions to improve poststroke spasticity, hand function, and functional tasks.
痉挛是中风后最常见和最使人丧失能力的运动障碍之一。
研究伸展干预措施（包括夹板固定）对降低上肢痉挛、提高手功能和改善上肢痉挛的成人功能任务的有效性的证据。
检索的数据库包括 MEDLINE、CINAHL、OTseeker、AgeLine 和 Cochrane 图书馆；结果仅限于 2004 年至 2017 年 1 月发表的研究。
根据 PRISMA 指南，我们纳入了描述 I-III 级研究的文章，这些研究的参与者为上肢痉挛且接受伸展干预的成年人。
符合纳入标准的 11 篇文章描述了 6 项 I 级和 5 项 III 级研究。
在降低上肢痉挛方面，有低强度的证据支持使用静态夹板固定，有高强度的证据支持使用伸展器械，有低强度的证据支持使用动态夹板固定；没有证据表明手动拉伸可以解决痉挛问题。在提高手功能方面，有中等强度的证据支持使用静态夹板固定、动态夹板固定和手动拉伸，有低强度的证据支持使用伸展器械。在改善功能任务方面，有中等强度的证据支持使用静态夹板固定、动态夹板固定和手动拉伸，有低强度的证据支持使用伸展器械。
本更新综述总结了目前关于伸展干预措施改善中风后痉挛、手功能和功能任务的有效性的文献。
