Application of upper-limb dynamic pseudoelastic splinting in the treatment of stroke chronic patient: a pilot assessment

Abstract

Purpose

The chronic sequelae of stroke are often a strong limitation to patient’s quality of life. New non-invasive elective treatments are required to support postural and functional improvements long after the primary insult. This study is an uncontrolled pilot evaluation of pseudoelastic orthotics for post-stroke upper-limb rehabilitation.

Materials and methods

Six chronic hemiplegic patients (3.8 ± 1.7 years since stroke) were evaluated with clinical scales, covering the ICF domains of body functions and structures (Modified Ashworth Score [MAS], Medical Research Council Scale for Muscle Strength, Fugl-Meyer [FM], Motricity Index [MI]), activities (Wolf Motor Function Test [WMF], Motor Activity Log [MAL]) and participation (quality of life questionnaires); sensors applied to the orthosis were used to assess changes in the articular and functional domains over a month’s treatment.

Results

Significant gains were achieved in elbow spasticity (MAS, p = .020), upper-limb motor function (FM, p = .005), reaching task (p = .035), and gait (p = .00046) speed. Most patients improved in functional tasks (WMF), but this did not reflect in daily-life activities as measured with MAL. Some patients reported an improved quality of life, especially the quality of sleep.

Conclusions

Pseudoelastic orthoses could be a comfortable and useful adjunct in the long-term management of stroke. Broader trials will have to confirm these preliminary observations.

Implications for rehabilitation

• Use of new materials in neuromuscular rehabilitation.

• Customised and adjustable therapeutic action obtained with dynamic personalised orthoses.

• Non-invasive interventions could be of help for patients with chronic disability.

Keywords:

• Stroke
• chronic patients
• dynamic orthoses
• functional materials
• customized treatment
• viscoelastic

Acknowledgements

The authors would like to thank Mr. Carlo Ceriotti for helping with orthosis sensorization, Dr. Eleonora Guanziroli for helping in patients’ enrollment, Mr. Gianluca Sammali for physiotherapeutic support in patients’ evaluation and Mr. Silvano Pirovano for the fabrication of the orthosis shells. The authors also thank the other members of the Riprendo@Home project for the useful discussions during the study preparation, in particular, Dr. Giovanna Rizzo, Dr. Marco Caimmi, Dr. Claudio Lafortuna and Dr. Matteo Malosio.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The present study was possible thanks to the partial support of Regione Lombardia and the National Research Council of Italy (CNR) under their framework agreement of 2012, through the Riprendo@Home project. This study was funded by Accordo Quadro Regione Lombardia – CNR, 2013–2015.