Customized adjustable orthoses: their use in spasticity.
Spastic contractures are a common problem which frequently requires the use of splinting or casting. Customized adjustable orthoses can reduce contractures without the problems often associated with these procedures. These devices reduced contractures in a head-injured patient's severely spastic wrist and ankles. As a wrist contracture decreased, the patient increasingly used her arm and hand for feeding, grooming, and leisure activities. The plastic orthoses, molded to the individual limb, incorporate Klenzak or Lehrman fracture brace joints. Custom fit positions spastic limbs and promotes improved range of motion. Small brace joint adjustments are done at intervals to promote slow stretch of spastic limbs; since the device remains on during the adjustment, there is no loss of range of motion. The device may be removed for skin monitoring. The patient maintains joint range, as the orthosis becomes a permanent part of the home program. High cost of the device is potentially offset by the advantages of decreased skin morbidity, reduced therapist time in making adjustment, and maintenance of gains in range of motion. Such orthoses also have been used for elbow contractures.