Short-term effects of dynamic lycra splints on upper limb in hemiplegic patients

Objective: To assess acceptability, effects on swelling, resting posture, s pasticity, and active (AROM) and passive range of motion (PROM) of individu ally tailored upper limb Lycra(R) garments, designed as dynamic splints to exert directional pull on certain limb segments, when worn for 3 hours by h emiplegic patients. Design: Crossover trial. Setting: Outpatient and inpatient rehabilitation center. Patients: Convenience sample of 16 patients with hemiparesis and upper limb spasticity caused by a stroke more than 3 weeks before the study. Interventions: Assessments performed at the start and end of a 3-hour perio d during a standard rehabilitation day when the patients were and were not wearing the garment. Main Outcome Measures: (1) Comfort assessed by questionnaire; (2) circumfer ence of each limb segment; (3) resting posture at elbow and wrist; (4) spas ticity at shoulder, elbow, and wrist using the Tardieu scale; and (5) AROM and FROM at shoulder, elbow, and wrist measured using a goniometer; (6) elb ow proprioception using McCloskey's method; (7) visual neglect syndrome usi ng the line bisection test. Differences between changes occurring with and without the garment were compared using Wilcoxon's signed rank test for ord inal variables (spasticity grading) and Student's t test for continuous var iables tall other data). Results: During 3 hours, garments worn on the arm by patients with hemipleg ia (1) were comfortable, (2) improved wrist posture and reduced wrist and f inger flexor spasticity, (3) reduced swelling in patients with swollen limb s (digit circumference decreased by 4%; p <.01), (4) improved FROM at shoul der (mean increase in range, 4.1<degrees> +/- 13.0 degrees per shoulder mov ement; p <.01); and (5) impaired ability to flex fingers (range of voluntar y flexion of digit III reduced from 107.3<degrees> +/- 79.6 degrees to 91.4 degrees +/- 74.1 degrees; p <.05). Conclusion: Lycra garments, designed to produce continuous stretch of spast ic muscles when worn for several hours each day, have rapid splinting and a ntispastic effects on wrist and fingers in patients with hemiplegia. These garments may help severely affected patients with major spasticity or painf ul swollen limbs.