Case Report: Flossing intervention for chronic upper limb spasticity after childhood-onset stroke

Upper limb spastic paralysis after stroke often limits functional use of the affected hand and restricts activities of daily living, particularly in cases with long-standing impairment following childhood-onset stroke. Although various interventions for spasticity have been reported, many require specialized equipment or invasive procedures, which may limit long-term and home-based use. Flossing intervention, which involves compressive wrapping with an elastic band combined with movement, has recently been introduced in musculoskeletal practice; however, its application for post-stroke spasticity remains unclear.

An adolescent girl in her teens (female, Asian) presented with long-standing right upper limb spastic paralysis following childhood-onset cerebral infarction associated with moyamoya disease. At baseline, she demonstrated marked distal spasticity, limited active wrist extension, and restricted functional use of the affected hand. A flossing intervention was applied to the distal forearm and elbow region, consisting of compressive wrapping followed by passive twisting and active movements. The intervention was performed both in outpatient therapy and as a home-based program. After 6 months of continuous intervention, Modified Ashworth Scale scores decreased, upper limb motor function assessed using the Fugl-Meyer Assessment improved, and real-world use of the affected hand assessed using the Motor Activity Log increased. Active wrist extension range of motion improved from -20° to 40°, and functional bilateral hand use, including button fastening, became possible. The patient reported improved ease of hand movement and high satisfaction, and functional gains were maintained during follow-up.

This case suggests that flossing intervention may be a feasible, non-invasive, and home-based treatment option for improving upper limb function in patients with long-standing post-stroke spastic paralysis following childhood-onset stroke. Further studies are required to clarify its efficacy and appropriate indications.