Neurorehabilitation splinting: theory and principles of clinical use

The use of splints in neurorehabilitation is common, with splints being used to meet varied clinical aims. This paper explores the use of splints after stroke and examines the rationale underpinning current use. It covers the use of splints to reduce spasticity, prevent contracture and improve activity. As well as presenting the theoretical rationale underpinning splinting as an intervention, it examines the current evidence from randomised trials testing the theories. In summary, there is strong evidence that wearing a splint all night has no additional effect in reducing spasticity over usual therapy or in preventing contracture, whether the wrist is splinted in neutral or in maximum extension. It is not surprising that splinting has not shown an effect on activity, given that there was little effect on the impairments that it was directed towards. In conclusion, it is now time to re-focus on improving muscle performance in order to enable activity rather than preparing the patient for function by affecting abnormal reflex activity.