It is never wise or in the best interest of the patient to only treat their symptoms – EXCEPT . . .
When we are fitting Restorative Medical’s Flex Technology splints to treat increased muscle tone and spasticity, it is always interesting to know the patients’ diagnosis and to determine the most probable cause of their “tone,” but with these patients our goal is to treat their symptoms to relax the increased tone, then relengthen any tissue that has shortened.
We want to feel the muscle. We want to observe not just the body part with which we are working, but the entire body. We want to listen to what they may say about what we are doing and also notice how they say it. We want to watch their non-verbal cues. Working with these patients requires consideration of their entire body, including posture and positioning, not just an injured joint as you would with typical orthopedic splinting.
Restorative work should never be uncomfortable – let alone painful! It should feel like a stretch you and I preform when we get up in the morning and lengthen our muscles to prepare for the day.
With our lost range of motion contracture patients, we stretch to relengthen – we do not re-stretch. We fit Restorative Medical (RM) devices to apply a comfortable prolonged low load passive stretch. Our goal is to mimic the quality stretch a therapist applies with his or her hands to provide that same stretch to continue the “therapy” for hours at a time for as long as they patient needs it – which is many times for the rest of their lives.
We want a nice comfortable stretch, but not aggressive enough to initiate the rebound effect from over-stretching that commonly occurs in patients with nerve damage in the brain or spinal cord that is contributing to the increased muscle activity. If this increased activity continues for too long and holds the tissue in a shortened length, the tissue tends to shorten to that length. That does not necessarily mean this is a permanent shortening, but the longer it remains in the shortened state, the more challenging it may be to relengthen it. Relengthening requires a process of prolonged low load passive stretch to begin to realign the proteins in the muscle to prepare it to be relengthened. RM splints help to relax tone and spasticity, then provide the therapeutic stretch to – typically over a long period of time – relengthen tissue as is possible.
Splints and braces have historically been of rigid designs to hold and support a fractured or otherwise injured body member in a specific plane to facilitate healing and function. They were not designed for patients with neurologically involved tone and spasticity. Rigidly attempting to hold a muscle in a lengthened state may increase the risk of initiating the stretch reflex, therefore rebounding back in a shortened state.
We do not know the potential of relengthening until we have carried out this process of first relaxing tone, then applying low load stretch with the understanding that it may require months and years. The other alternative is to do nothing while their joints and body parts continue to contract.
Karen L. Bonn, RN, COF