Use of a Resting Hand Orthosis for the Hemiparetic Hand After Stroke

A 50-year-old right-handed man has been admitted to your stroke service after sustaining a left middle cerebral artery stroke. This is his first stroke. After an acute hospital stay of 5 days, he was admitted to inpatient rehabilitation. On admission to the rehabilitation unit, he presented with an essentially flaccid right arm, which demonstrated some synergistic movements (Fugl-Meyer, 8/66). Right upper extremity range of motion was well preserved, with no evidence of pain with passive movement. Sensation was diminished throughout the right side, with decreased perception of sharpness and extinction with double simultaneous stimulation to light touch. Proprioception was impaired in the fingers and wrist. After 3 weeks, improvements are noted in the proximal right upper extremity because he can now easily move the arm synergistically as well as demonstrate some shoulder flexion and abduction out of synergy. There now is concern over the possibility of loss of range of motion in the hand and wrist because passive range of motion is more difficult (Ashworth score, 2), with some evidence of pain near the end range, especially when extending the wrist and fingers. There is some active flexion of the wrist and fingers synergistically, but no active extension is noted. The occupational therapist recommends the use of a resting wrist-hand orthosis. Do you agree?
Source: PM and R - Category: Rehabilitation Authors: Tags: Point/Counterpoint Source Type: research