231 Top Stroke Rehabil 2011;18(3):231–237 © 2011 Thomas Land Publishers, Inc. www.thomasland.com doi: 10.1310/tsr1803-231 Short- and Long-Term Effects of an Inhibitor Hand Splint in Poststroke Patients: A Randomized Controlled Trial Erel Suat, PT, PhD, 1 S ¸ims¸ek I · brahim Engin, PT, PhD, 2 Bek Nilgün, PT, PhD, 3 Yakut Yavuz, PT, PhD, 3 and Uygur Fatma, PT, PhD 3 1 Pamukkale University, School of Physical Therapy and Rehabilitation, Denizli, Turkey; 2 Abant I · zzet Baysal University, School of Kemal Demir Physical Therapy and Rehabilitation, Bolu, Turkey; 3 Hacettepe University, Faculty of Health Sciences, Physical Therapy and Rehabilitation Department, Ankara, Turkey Purpose: To evaluate the effects of a hand splint with reflex inhibitory characteristics on balance and functional ambulation activities by means of a randomly allocated controlled study. Methods: Nineteen chronic stroke patients were randomly allocated to the control (n = 9) and study (n = 10) groups to compare the immediate and long-term effects of a splint with reflex inhibitory characteristics. The patients in the splinted group were asked to wear their splints at least 2 hours each day, during ambulation or when they felt the need. Subjects were evaluated initially and after 2, 4, and 6 months of splint usage with the Berg Balance Scale, Functional Reach test (FR), Timed Up & Go test (TUG), and L test. The same tests were used to evaluate the control group. Results: Timed within-group assessments showed no difference in the control group across the time interval. A favorable difference was detected in some of the evaluations for FR, TUG, and L test in the study group. Intergroup comparisons showed that the only difference between the groups was seen for TUG values at the fourth assessment in favor of the study group. Qualitative evaluations showed that the patients were compliant and generally satisfied with their splints. Conclusion: Hand splints with reflex inhibitory characteristics have no significant effect on balance and functional ambulation activities in chronic poststroke patients. Further studies investigating their effect on pain and associated reactions in this patient population are warranted. Key words: hemiplegia, spasticity, splint U pper limb dysfunction is a common and disabling consequence of adult stroke. A survey carried out in 1981 for splinting after stroke has shown that there are various clinical aims, design principles, materials, and wearing schedules. 1 Despite the widespread use of hand splints for adult stroke patients, few studies have examined the effect of splinting in a scientific manner so that there is insufficient evidence to either support or refute the effectiveness of hand splinting for this population. 2,3 The same is also true for upper extremity casting. 4 In a systematic review of the effectiveness of hand splinting for adults following stroke, Lannin 3 stated that despite the variety of aims there are only 2 theoretical rationales for splinting, the biomechanical and neurophysiological; whereas those who apply the biomechanical rationale recommend splinting to prevent length-associated changes in muscles and connective tissue, those who apply neurophysiological rationale recommend splinting to inhibit reflexive contraction of muscle. Although most studies have directly measured spasticity by means of the Modified Ashworth Scale (MAS), electrophysiology, range of motion, or pain, none have tried to measure the effect of splinting on functional ambulation activities even though it is a known fact that improvements in motor indicators do not always translate to functional gains. There are studies assessing the effect of tone-inhibiting ankle foot orthosis on upper extremity function. 5-7 However, there is no study in the literature evaluating the effect of a reflex inhibitory splint (RIS) on balance and functional ambulation activities with measures such as the Berg Balance Scale (BBS), Functional Reach test (FR), Timed Up & Go test (TUG), or L test. With this objective, we designed the study as a randomized controlled trial to compare the Grand Rounds Elliot J. Roth, MD, Editor