26th November 2019

In all my 23 years of practice I have not helped but notice the amount of splints that end up in patients’ cupboards or waste sites. I have also been frustrated by how futile it seemed, that no matter what many of my colleagues and I did on spastic upper limbs, the intermediate and long term outcomes were never positive for impairment and function.

The good thing is that it made me dig deeper into the neurosciences. I have learnt a lot that is now benefitting my chronic stroke patients. Since the year 2005, when evidence suggested that forceful passive stretching of tight spastic flexors only led to unobservable micro tears which change regular dense connective tissue to subsequently harder to stretch irregular dense connective tissue, I stopped stretching flexors.

So what is to be done? Muscle tone is modulated by reticular and vestibular spinal tracts’ actions on inhibitory spinal interneurons. Stimulating the anti-gravity extensor systems automatically improves reciprocal inhibition of the flexors and for the first time in my practice I am noticing improvements in impairment with voluntary movements eventually expressing themselves. Function then improves; all with no forceful stretching or use of splints. At the UKSF 2019 presentations on the subject of spasticity after stroke, were emphasizing targeting the antagonists when managing spasticity. The roles of the reticular formation and the central vestibular system were also highlighted. Putting science into practice may ease the pain and discomfort chronic stroke patients experience.