Upper extremity flexion synergy patterns may be seen in individuals who have experienced a cerebral vascular accident. The synergy pattern may result in limited functional movement, deformities and contractures of the involved limb, and prevention of appropriate hygiene of the extremity. Therapeutic iritervention may assisUn the prevention of the aforementioned effects of a synergy pattern. Clinically, abduction of the thumb and supination of the forearm has been advocated to decrease upper extremity tone in order to perform functional activities with greater range of motion of the joints in the involved extremity. The study examined the effect of the Smith and Nephew Tone and positioning (T.A.P.) splint, which positions the thumb in abduction and the forearm midway between pronation and supination, upon the following upper extremity joint angles: shoulder flexion, shoulder adduction, elbow extension, forearm pronation, and wrist extension. A single subject with mild spasticity producing an upper extremity flexion synergy pattern participated in the study. Utilizing an A-A-B-A-B-A-B design the subject's upper extremity joint angles were measured weekly using the PEAK Three-dimension Motion Analysis System over a six week period. To study these angles, "reaching" forward on a table was chosen as the functional task. The videotaped reaches were digitized and analyzed with the motion analysis system. The two standard deviation band method was utilized for statistical analysis of the data given by the motion analysis system.
Statistically significant differences occurred in shoulder flexion, elbow extension and wrist extension over the period of the study. Despite the statistically significant differences, data failed to reveal statistically significant differences between the splinting conditions. In other words, the T.A.P. did not appear to significantly influence the upper extremity joint angles. However, there was a progressive increase in the degree of elbow extension over the period of the study. The increases in elbow extension angles were most likely due to practice effects and an increase in triceps strength rather than any direct effect from use of the splint. There were no statistically significant differences in shoulder adduction and forearm pronation.
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