Combined Bracing, Electrical Stimulation, and Functional Practice for Chronic, Upper-Extremity Spasticity Kathleen Hardy, Kacia Suever, Amie Sprague, Valerie Hermann, Peter Levine, Stephen J. Page KEY WORDS  braces  combined modality therapy  electric stimulation  muscle spasticity  task performance and analysis  upper extremity Kathleen Hardy, MS, OTR/L; Kacia Suever, MS, OTR/L; and Amie Sprague, MS, OTR/L, were Graduate Students, Master of Occupational Therapy Program, Xavier University, Cincinnati, OH, at the time of the study. Valerie Hermann, MS, OTR/L, is Research Occupational Therapist, Department of Rehabilitation Sciences, University of Cincinnati Academic Medical Center (UCAMC), Cincinnati, OH. Peter Levine, PTA, is Senior Research Assistant, Department of Rehabilitation Sciences, UCAMC, Cincinnati, OH. Stephen J. Page, PhD, OTS, is Associate Professor, Departments of Rehabilitation Sciences; Physical Medicine and Rehabilitation; Neurology; and Neurosciences, UCAMC; Director, Neuromotor Recovery and Rehabilitation Laboratory, Drake Rehabilitation Center, Cincinnati, OH; and Member, Greater Cincinnati/Northern Kentucky Stroke Team, UCAMC, 3202 Eden Avenue, Suite 315, Cincinnati, OH 45267-0394; Stephen.Page@uc.edu. Page is also a student in the Occupational Therapy Program at The University of Findlay, Findlay, OH. OBJECTIVE. Conventional methods for managing upper-extremity (UE) spasticity are invasive, usually require readministration after a certain time period, and do not necessarily increase UE function. This study examined efficacy of combining two singularly efficacious modalities—UE bracing and electrical stimulation—with functional training to reduce UE spasticity and improve function. METHOD. Two chronic stroke patients exhibiting UE spasticity were administered the Modified Ashworth Scale (MAS), the upper-extremity section of the Fugl-Meyer Impairment Scale (FM), the Box and Block Test (B&B), and the Arm Motor Ability Test (AMAT). They were then individually fitted for a brace and sub- sequently participated in treatment sessions occurring 2 days/wk for 5 wk, consisting of (1) 30-min clinical sessions, during which the UE was braced in a functional position while cyclic electrical stimulation was applied to the antagonist extensors of the tricep and forearm, and (2) 15-min, clinically based training sessions, occurring directly after the clinical session. RESULTS. After intervention, participants exhibited 1-point reductions in MAS scores for the affected fingers, FM score increases, and increased ability to perform AMAT activities,. Three months later, both participants retained these changes. CONCLUSION. Data point to a noninvasive, promising method of managing spasticity and rendering functional changes. Hardy, K., Suever, K., Sprague, A., Hermann, V., Levine, P., & Page, S. J. (2010). Combined bracing, electrical stimulation, and functional practice for chronic, upper-extremity spasticity. American Journal of Occupational Therapy, 64, 720– 726. doi: 10.5014/ajot.2010.08137 S troke remains the leading cause of disability in the United States, and it causes upper-extremity (UE) impairments in >80% of survivors (Rosamond et al., 2007). Among the myriad stroke-induced impairments, UE spasticity may be one of the most devastating, because it can be painful, frequently compromises performance of activities of daily living (ADLs), and diminishes independence (Sommerfeld, Eek, Svensson, Holmqvist, & von Arbin, 2004). Consequently, treatments that decrease spasticity and increase functional ability are urgently needed (Gustafsson & McKenna, 2003, p. 205). The most promising UE spasticity treatments involve pharmacologic man- agement. For example, many studies have reported significantly reduced UE spasticity using selective chemodenervation with botulinum toxin A (BTX; see Cardoso et al., 2005, for a review). Others have reported spasticity reductions after injecting alcohol or phenol into a specific nerve (Kong & Chua, 1999) or administering antispastic medications intrathecally (Ivanhoe, Francisco, McGuire, Subramanian, & Grissom, 2006) or orally (Meythaler, Clayton, Davis, Guin- Renfroe, & Brunner, 2004). Although promising, these approaches are invasive and often require readministration, and the procedures and medications in- volved in these techniques are not always covered by patients’ insurance. More important, spasticity reductions brought about by these techniques do not necessarily lead to functional improvements (Gallichio, 2004). 720 September/October 2010, Volume 64, Number 5 Downloaded from http://ajot.aota.org on 05/24/2020 Terms of use: http://AOTA.org/terms