Improving Elbow and Wrist Range of Motion Using a Dynamic and Static Combination Orthosis

In Brief This pilot study examined the efficacy of improving range of motion at both the elbow and wrist using a dynamic and static combination orthosis. The sample population included six children, two females and four males with a mean age of 12 years, 6 months with a primary diagnosis of cerebral palsy. Among the sample, five children received an orthotic device for one arm and one child received an orthotic device for each arm. None of the children demonstrated functional use of the involved limb, and all experienced moderate spasticity interfering with passive movements at elbow and wrist. Upper extremity range of motion was assessed using goniometric measurements of passive range of motion, and tone was evaluated using the Modified Ashworth Scale. One subject received a botulinum toxin (BtA) injection to both left and right upper limb, and another subject received to the right upper limb. All participants underwent serial casting of the wrist for 3 to 4 weeks, followed by application of an Ultraflex (Ultraflex Systems Inc., Pottstown, PA) orthosis. Caregivers were asked to increase daily Ultraflex wear time from 1 hour to 5 hours or more. Range of motion and tone assessments were taken at five different intervals throughout the study: preintervention, and at 2, 3, 6, and 10 months. Among the subjects who wore the Ultraflex brace according to the outlined protocol, improvements were seen at the 10-month assessment in passive range of motion at either the elbow or wrist or in both joints in five of the seven limbs examined. The results demonstrate a positive statistical correlation between brace wear and range of motion at the elbow and wrist as compared with those who did not wear the brace. Because of the small sample size, the effects of BtA in conjunction with Ultraflex orthosis wear on range of motion was limited. In addition, four of the six caregivers reported their children primarily wore the Ultraflex orthosis during school hours, and for a limited time after school hours. Two subjects did not comply with the protocol, and the range of motion declined from the original baseline. The long-term prognosis of maintaining range of motion will ultimately depend upon the family’s ability and willingness to comply with the prescribed treatment. Further studies investigating compliance at home and working with the school are needed. The results of this study indicate a positive statistical correlation between wear of this orthosis and range of motion. Children with increased tone of the upper extremity and joint contractures need to have range of motion consistently monitored to prevent skin breakdown, to improve hygiene, and to assist with ease of care. In the past 20 years less cohesiveness has occurred between school and hospital therapists. This pilot study demonstrates that to truly serve children with disabilities, a partnership between hospital, school and home is required.