I wondered what would happen if I continued to do passive stretching and active hand exercises, but stopped wearing my resting splint at night. After a month of not wearing this splint I could feel my thumb getting tighter. I resumed wearing my splint and the next morning I woke up with a wicked ache in my thumb. My thumb is tight by bedtime so my splint has not eliminated spasticity. Placing the hand in one static position does not retrain the brain to produce active range of motion (AROM). Yet I believe my splint has prevented a painful permanent contracture.
Stroke is a global public health problem that leads to significant disabilities (World Health Organization, 2014). After discharge from a hospital, patients who have experienced stroke return to the community and many do not have access to physical therapy. Around 65% of patients who had experienced a stroke were unable to use their hemiparetic upper limb (Bruce and Dobkin, 2005). Those with moderate to severe arm deficits have difficulty in reaching to grasp, delay in time to maximal grip aperture, prolonged movement time, and a lack of accuracy (Michaelsen et al, 2009). A number of interventions have been proven to be effective in improving upper limb function post-stroke. However, there is little evidence of the effectiveness of these interventions for those with severe deficits.
The therapy programme based on the Bobath concept has been shown to improve upper limb function in individuals who have experienced chronic stroke (Huseyinsinoglu et al, 2012; Carvalho et al, 2018). The Bobath concept has been in evolution and the present clinical framework incorporates the integration of postural control and quality of task performance, selective movement, and the role of sensory information to promote normal movement pattern. Therapeutic activities involved movement facilitation together with patient’s active participation in practice to improve motor learning; nevertheless, implementation time varied across studies (Vaughan-Graham et al, 2009; Vaughan-Graham and Cott, 2016).
Among the few studies of patients with chronic stroke, none focused on the rehabilitation of patients with different degrees of deficit severity in the community. Moreover, previous studies using the Bobath concept were all conducted in clinical settings (Platz et al, 2005; Huseyinsinoglu et al, 2012).[…]