Efficacy of Dynamic Splinting on Plantar-Flexion Tone and Contracture Seen in CVA and TBI Patients: a Controlled, Cross-Over study

The purpose of this study was to examine the efficacy of low-load, prolonged-duration stretch with dynamic splinting in reducing ankle contracture for stroke (CVA) and traumatic brain injury (TBI) patients. This controlled, cross-over study lasting six months was conducted at multiple outpatient facilities across the USA. Fifty volunteer patients (30 CVA and 20 TBI) who were one year or more post-incident took part in this study, and each presented with a preexisting plantarflexion contracture. All patients were treated with standardized therapeutic protocols (2/wk) for six months and ROM measurements were taken at enrollment, three and six months. Selected patients were “crossed-over” into experimental groups, as prescribed by their physicians (25 CVA and 15 TBI) for the final three months of this study, receiving additional treatment with dynamic splinting (DS) in dorsiflexion. The dependent variable was the maximal ankle dorsiflexion measured in PROM, and there was a significant change for the cross-over patients, (p = 0.007). Preexisting excessive plantarflexion contracture was effectively reduced with DS for six months. Aim Cerebral Vascular Accident (CVA) is the third leading cause of death and the top leading cause of long-term disability in the United States. This condition which affects over 1,000,000 patients per year, often shows the complication of hemiparesis and excessive neuromuscular tone (hypertonicity) in excessive plantar flexion as a frequent complication. Over 1,500,000 individuals in America have suffered a Traumatic Brain Injury (TBI) and while the severity may vary, more than 70,000 TBI patients live with long-term or lifelong disability resulting from these injuries. Methodist Rehabilitation Associates, Houston, Texas; Jones & Cowen Physical Therapy, Giddings, Texas; Texas State University (HPER Dept.) and Dynasplint Systems, Inc., Clinical Research Hypertonicity in plantar flexion is a frequent complication of TBI, and if not addressed with appropriate therapies and/or treatments, the tone can then cause contracture. The source of hypertonia is considered to be attributed to infarct or damage to the upper motor neuron (UMN) which results in decreased inhibition. In such a case, the gamma motor neurons will receive excess signals for muscle contraction and without inhibition from the UMN, the increased stimulation will yield tetany and hypertonia. Contracture is shortening of the connective tissue which results from hypertonia and decreased activation of antagonistic muscle. or following immobilization of fractures. Contracture has routinely been treated with interventions ranging from passive range of motion (PROM) stretching to botulinum toxin