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Inhibition of flexor tone
flexion, status/post gunshot wound to the metacarpal. Results: In all patients, there was a high compliance rate with wearing the yoke. We believe the patients fitted to improve alignment or balance complied because the yoke is small and comfortable and their function improved. In fact, three of the patients discharged from therapy have subsequently returned for fabrication of a replacement of their ‘‘permanent adaptive splint.’’ The two patients who wore the splint to assist in increasing ROM gained flexion of the MCP or PIP joints being addressed. Their ROM charts will be presented. Conclusion: The ICAM yoke is well tolerated and effective in balancing or aligning many hand problems affecting the biomechanics of the MCP joint. The improved function experienced by some of the patients fitted is demonstrated by their desire to have replacements or ‘‘back-up yokes’’ fabricated. The ICAM yoke is also an effective splint to position one or more finger MCP joints in relative extension or flexion to gain motion at the MCP or PIP joints. Inhibition of Flexor Tone. Beth U. Coon, PT, CHT, William R. Mattingly, OTR/L Purpose: The purpose of this study is to demonstrate a progressive use of neuromuscular electrical stimulation (NMES) by using a systematic approach to the reduction of spasticity. Spasticity can limit function in patients after a cerebral vascular accident (CVA). Flexor synergistic patterns present with variable tone and frequently respond well to electrotherapy. Previous treatment protocols use the approach of stimulating spastic musculature to fatigue or antagonistic musculature to strengthen and facilitate (Currier, 1983). This protocol utilizes an electromesh glove after 30 minutes of antagonistic muscle facilitation to stimulate intrinsic muscle contraction, allowing facilitation of digital extension and abduction, therefore reducing tone and allowing static progressive splinting to minimize tone. Method: Three patients presented after left-sided flexor synergistic tone at approximately 60 degrees of wrist
flexion with digital composite flexion, elbow at 40 degrees of flexion without volitional control. NMES was used to stimulate the antagonistic muscle groups consisting of extensor carpi radialis longus and brevis (ECRL/B), extensor digitorum communis (EDC), and triceps. Channel 1 was applied to the triceps to facilitate elbow extension for increased reach envelope for improved functional use of the hand and ease for splinting. Channel 2 was applied to the wrist extensors to facilitate wrist position and digital extension for appropriate pre-contact grasp formation. This configuration was applied for 30 minutes using an alternating ramped burst program with an asymmetrical waveform for same musculature. Channel 2 started after channel 1 had completed the cycle. Channel 1 gradually increased intensity for 0.5 seconds, and then held a set intensity for 5.0 seconds and then decreased intensity over 0.5 seconds. Channel one is then off for 6.0 seconds. As channel intensity is decreasing, channel 2 started increasing intensity, via the same pattern. The negative electrode was placed over motor point with cycle rates used to produce tetany at 25–50 pps (the minimum rate that produced a good tetanized contraction dependent on tone) (Kahn 1987). An electromesh glove was fitted with repositioning of proximal electrodes utilizing channel 2, after stimulation of the antagonistic musculature permitted positioning of the wrist in neutral. The electromesh glove was worn for an additional 30 minutes. A static progressive splint with a wrist hinge hand portion was fabricated over the electromesh glove. The splint is to be worn after application of the above NMES protocol permits wrist at neutral or into extension. Observation: The patients presented with the wrists at neutral after a progression of NMES to triceps and ECRL/B and EDC. Reduction of hand intrinsic musculature tightness was achieved after use of the electromesh glove along with reduction of extrinsic flexor synergistic tone. Reduction of tone allowed ease of static progressive splinting with a hinged wrist splint. Conclusion: Flexor spasticity can be a hindrance to personal hygiene and impedes functional activity. This
method of using NMES and electromesh glove to initiate elbow extension, wrist extension, and digital extension with abduction promotes interference to the flexor synergistic pattern of the upper extremity, eliciting motor contraction of previously inactive extensor musculature. Thumb and Pinch Weakness in De Quervain’s Disease. Katia Fournier, BScOT, Daniel Bourbonnais, PhD, Jose´e Arsenault, MScOT, Patrick Harris, MD Purpose: Although de Quervain’s disease affects tendons involved in the abduction and extension of the thumb, strength impairments caused by this disease are often measured with a pinch gauge that quantifies the thumb flexion and opposition forces. The purpose of this preliminary study was to describe strength impairments associated with de Quervain’s disease in adduction, extension, abduction, and flexion of the thumb using a bi-axial dynamometer and in palmar pinch using a pinch gauge. Subjects: Convenience sample of 14 subjects aged 36 to 68 with unilateral de Quervain’s disease. Subjects had to be free of any other pathological condition affecting the hand. Nine subjects were affected on their dominant side. Method and materials: A bi-axial dynamometer was used to assess isometric maximal voluntary contraction (MVC) exerted in the transverse plane at the proximal phalanx of both thumbs of subjects. MVC was tested in four directions: adduction, extension, abduction, and flexion, four trials being made per direction. Directions of efforts required and subjects MVC were displayed on a monitor giving a visual feedback. Palmar pinch strength measurements were also taken for both hands with a pinch gauge (three trials). Analysis: A two-way repeatedmeasures analysis of variance (ANOVA) was performed on the MVC values obtained with the bi-axial dynamometer (factors: sides and directions) and a paired Student’s t-test was performed on the MVC values obtained with the pinch gauge. Ratios of MVC (symptomatic/asymptomatic side) were also calculated for both instruments.
January–March 2004
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flexion with digital composite flexion, elbow at 40 degrees of flexion without volitional control. NMES was used to stimulate the antagonistic muscle groups consisting of extensor carpi radialis longus and brevis (ECRL/B), extensor digitorum communis (EDC), and triceps. Channel 1 was applied to the triceps to facilitate elbow extension for increased reach envelope for improved functional use of the hand and ease for splinting. Channel 2 was applied to the wrist extensors to facilitate wrist position and digital extension for appropriate pre-contact grasp formation. This configuration was applied for 30 minutes using an alternating ramped burst program with an asymmetrical waveform for same musculature. Channel 2 started after channel 1 had completed the cycle. Channel 1 gradually increased intensity for 0.5 seconds, and then held a set intensity for 5.0 seconds and then decreased intensity over 0.5 seconds. Channel one is then off for 6.0 seconds. As channel intensity is decreasing, channel 2 started increasing intensity, via the same pattern. The negative electrode was placed over motor point with cycle rates used to produce tetany at 25–50 pps (the minimum rate that produced a good tetanized contraction dependent on tone) (Kahn 1987). An electromesh glove was fitted with repositioning of proximal electrodes utilizing channel 2, after stimulation of the antagonistic musculature permitted positioning of the wrist in neutral. The electromesh glove was worn for an additional 30 minutes. A static progressive splint with a wrist hinge hand portion was fabricated over the electromesh glove. The splint is to be worn after application of the above NMES protocol permits wrist at neutral or into extension. Observation: The patients presented with the wrists at neutral after a progression of NMES to triceps and ECRL/B and EDC. Reduction of hand intrinsic musculature tightness was achieved after use of the electromesh glove along with reduction of extrinsic flexor synergistic tone. Reduction of tone allowed ease of static progressive splinting with a hinged wrist splint. Conclusion: Flexor spasticity can be a hindrance to personal hygiene and impedes functional activity. This
method of using NMES and electromesh glove to initiate elbow extension, wrist extension, and digital extension with abduction promotes interference to the flexor synergistic pattern of the upper extremity, eliciting motor contraction of previously inactive extensor musculature. Thumb and Pinch Weakness in De Quervain’s Disease. Katia Fournier, BScOT, Daniel Bourbonnais, PhD, Jose´e Arsenault, MScOT, Patrick Harris, MD Purpose: Although de Quervain’s disease affects tendons involved in the abduction and extension of the thumb, strength impairments caused by this disease are often measured with a pinch gauge that quantifies the thumb flexion and opposition forces. The purpose of this preliminary study was to describe strength impairments associated with de Quervain’s disease in adduction, extension, abduction, and flexion of the thumb using a bi-axial dynamometer and in palmar pinch using a pinch gauge. Subjects: Convenience sample of 14 subjects aged 36 to 68 with unilateral de Quervain’s disease. Subjects had to be free of any other pathological condition affecting the hand. Nine subjects were affected on their dominant side. Method and materials: A bi-axial dynamometer was used to assess isometric maximal voluntary contraction (MVC) exerted in the transverse plane at the proximal phalanx of both thumbs of subjects. MVC was tested in four directions: adduction, extension, abduction, and flexion, four trials being made per direction. Directions of efforts required and subjects MVC were displayed on a monitor giving a visual feedback. Palmar pinch strength measurements were also taken for both hands with a pinch gauge (three trials). Analysis: A two-way repeatedmeasures analysis of variance (ANOVA) was performed on the MVC values obtained with the bi-axial dynamometer (factors: sides and directions) and a paired Student’s t-test was performed on the MVC values obtained with the pinch gauge. Ratios of MVC (symptomatic/asymptomatic side) were also calculated for both instruments.
January–March 2004
79