OBJECTIVE. We investigated the effect of a combined neuromuscular electrical stimulation (ES) and dynamic hand orthosis (DHO) regimen with a group of people with chronic stroke to improve performance on specific daily tasks. METHOD. Four people with chronic stroke participated in an ES–DHO regimen using the affected upper extremity 5×/wk for 6 wk. Outcome measures included grip strength, range of motion (ROM), and analysis of muscle activation–deactivation during release of grasp through electromyography. Ability to perform specific daily living tasks was assessed using the Assessment of Motor and Process Skills (AMPS). RESULTS. Results suggested that improvements in strength, ROM, and grasp deactivation are possible with the combined ES–DHO regimen. All participants’ AMPS motor scores improved. CONCLUSIONS. An ES–DHO regimen may improve motor skills needed for functional task performance in people with chronic stroke. Results should be interpreted cautiously because of the pilot nature of the study and the small sample size.

This study is the first phase of research aimed at developing new educational approaches to enhance occupational therapy students’ orthosis fabrication skills. Before the effectiveness of training can be determined, a method for evaluating performance must be established. Using the Delphi method, we developed a global rating scale and checklist for evaluating technical competence when fabricating metacarpophalangeal (MCP) joint–stabilizing orthoses. To determine the reliability and validity of these tools, three evaluators used them to assess and score orthotic fabrication performance by experienced and student occupational therapists. The results suggest that these measurement tools are valid and reliable indicators of the technical skills involved in fabricating an MCP joint–stabilizing orthosis. Future studies should focus on building on these tools to evaluate communication skills, technical skills for making other types of orthoses, and effectiveness of training programs.

OBJECTIVE. This study compared the total wrist range of motion permitted by four different styles of wrist extension orthoses and the free hand. METHOD. Using a repeated-measures, counterbalanced design, 40 healthy female volunteers 20 to 39 years of age shot a basketball while free handed and while wearing each of four wrist extension orthoses: AlignRite; Rolyan D-Ring Long; Rolyan D-Ring Short; and a custom-made, thumb hole design orthosis. The motion at the wrist was measured by an electrogoniometer. RESULTS. No significant differences were found in total wrist motion permitted among the four orthotic conditions. Analyses revealed that the custom-made orthosis allowed significantly less palmar flexion and significantly more dorsiflexion than the three commercially available orthoses. All orthoses significantly restricted wrist movement compared with the free hand. CONCLUSION. The commercially available wrist extension orthoses offered little difference in the amount of restriction they provided. The custom orthosis restricted movement to a different portion of the available range than did the commercial orthoses. Future research should examine how different strapping techniques on custom-made orthoses affect total range of motion permitted at the wrist. Knowledge of patterns of restriction among various styles of orthoses will help therapists to select the most appropriate orthosis for a client‘s individual needs.

Objective. This study examined the effect of commonly used long and short styles of commercially produced wrist extension orthoses on the activity of the proximal muscles of the shoulder and elbow and on wrist flexor and extensor muscle activity. Method. While 17 women between 22 and 40 years of age (M = 26.6) performed a specified movement wearing each of the two styles of orthosis and without an orthosis, their motor unit recruitment of five proximal joint muscle groups, wrist extensors, and wrist flexors was measured by surface electromyography. Results. Motor unit recruitment was significantly greater in both orthosis conditions for four of five proximal muscles and for wrist flexors. There were no significant differences between the short and long orthosis conditions for proximal muscle groups. Conclusion. Wearing a wrist extension orthosis appears to place additional stress on the proximal joint musculature beyond that found without splint use. The study has implications for the prescription of wrist extension orthoses, especially for patients whose proximal joints are already compromised.

Objective. This retrospective study examined the use of low-load prolonged stretch (LLPS) orthoses for contracture management. Method. The records of 17 patients from skilled nursing facilities, hand clinics, and hospitals were reviewed. There was a total of 18 contractures (2 wrist, 12 elbow, 4 knee) secondary to neurological and orthopedic pathologies. Chart review focused on patient demographic information, range of motion (ROM) and functional outcomes, and wear schedules. Results. The use of LLPS orthoses significantly increased ROM for the whole sample, which in turn significantly improved the subjects functional outcomes. When the sample was divided into two pathology groups to compare a predominately geriatric population with neurological pathologies to a somewhat younger population with a history of musculoskeletal pathology, both groups showed a significant gain in ROM with the use of the LLPS orthoses. Conclusion. Use of LLPS orthoses for contracture management can mediate the losses in ROM and function that occur with joint contractures.

Objective. Five styles of commercial static wrist extensor orthoses were compared to determine whether any style, or styles, afforded better power grip strength or finger dexterity. Because wrist extensor orthoses are intended for use during functional tasks, their influence on hand function is of great importance. Method. Twenty-three right-hand-dominant women without upper extremity dysfunction participated in this crossover study. Dominant-hand finger dexterity and power grip strength were evaluated while wearing each of five commercial orthoses–Kendall–Futuro #33^® (Futuro), AliMed Freedom Long^® (AliMed Long), AliMed Freedom Short^® (AliMed Short), Smith & Nephew Rolyan D-Ring^® (Rolyan), and LMB Wrist Rest^® (LMB) –and while using the dominant hand without an orthosis (free hand). Finger dexterity was assessed with the unimanual subtest of the Purdue Pegboard. Grip strength was assessed with a Jamar^® hydraulic dynamometer. Results. Four of the study orthoses (Futuro, AliMed Short, Rolyan, and LMB) afforded finger dexterity that did not differ significantly from that of the free hand. The AliMed Long orthosis slowed finger speed when compared with the speeds afforded by both the LMB orthosis and the free hand. The Rolyan orthosis permitted a power grip strength that was not significantly different from the free hand. The other four commercial orthoses reduced grip strength when compared with the strength observed when wearing a Rolyan orthosis and when gripping with a free hand. Conclusion. The five styles of commercial orthoses affect power grip and finger dexterity differently. When power grip or finger dexterity are priorities, differences among the orthoses furnish grounds for initial suggestions, although medical needs and patient preference should be the overriding factors in the final selection of an orthosis.

Objectives. Much has been written about the use of static orthoses to maintain proper position and prevent deformity, but there are few empirical data to determine whether static orthoses improve function, maintain range of motion, or prevent deformity in the hand. Method. This study measured gains in hand function during a 3-month rehabilitation period in 13 persons with sixth cervical (C-6) level complete quadriplegia, 7 of whom wore a static orthosis at night (experimental group) and 6 who did not wear the orthosis (control group). Hand function, range of motion and strength were measured in all subjects 4 weeks and 8 weeks after the study commenced, and again after 12 weeks in only 69% of the subjects. Results. No significant differences were found in hand function between control and experimental groups; hand function had improved significantly in all 13 subjects. Conclusion. As the effects of deformity have been clinically observed, future studies should examine the effects of static orthoses with increased daily wear or wear over a longer period of time.

Orthoses that are used to stabilize, protect, and support the wrist during functional activities often interfere with normal movement and, therefore, with hand function. This study compared the manual dexterity and grip strength of 20 female subjects while using a free hand and while wearing each of four wrist extensor orthoses: a Futuro prefabricated wrist brace (No. 33), a volar thumbhole orthosis, a volar orthosis with a radial connector bar, and a dorsal orthosis with distal transverse arch support. Of these orthoses, the Futuro prefabricated wrist brace afforded the best overall dexterity, although it was significantly slower (p < .05) than the other orthoses in a writing subtest. Of the custom-made orthoses, the volar style with radial connector bar afforded the best overall dexterity. All of the orthoses significantly (p < .01) reduced grip strength. The Futuro prefabricated wrist brace afforded the strongest grip strength of the four orthoses studied, and the volar thumbhole orthosis permitted the strongest grip among the custom-made orthotic styles.

A modification of the Kleinert orthosis providing early controlled mobilization following flexor tendon repair is presented in the article. Ongoing evaluations of the efficacy of the splint are described and implications for use in treatment are reviewed. The views expressed in this paper are those of the authors and do not reflect official United States Army or U.S. Department of Defense Policy.