A frequent outcome after sustaining a stroke is a change in the muscles' ability to move. Depending on the location of the stroke, different muscle groups are affected. Most commonly seen is hemiplegia where one side of the body becomes weaker than the other side. For example, if your child experiences a stroke on the right side of the brain, your child may experience muscle weakness in the left arm, leg, and face. Each child's weakness or hemiplegia will be different depending on the location, type, and severity of the stroke.
In addition to muscle weakness, many children have spasticity or hypertonicity in the muscles of the weaker side. Spasticity is when a muscle tightens involuntarily and is stiff. Spasticity is observed when a child keeps his/her hand in a fisted position and/or the elbow in a bent position. In the legs, your child may keep his/her toes pointed down and/or inward and/or his/her knees bent. It can be difficult to stretch your child's arms and legs due to the stiffness. Your child may not be stiff at rest, but the spasticity or stiffness may increase when your child attempts to move the affected muscles.
There are a variety of treatment options to manage spasticity. Treatments are specifically designed for each child as each child's level of spasticity is different. There are surgical and pharmacological treatments for spasticity in more severe cases. Visit our Orthopaedics site for information on this type of treatment.
However, spasticity is most commonly treated with passive range of motion (stretching) and splinting. Your child may be too weak to stretch his/her muscles. It is very important that caregivers provide this stretching throughout the day to keep the muscles as loose as possible. Additionally, there are a variety of splinting options that may be recommended in order to best manage your child's spasticity.
A resting hand splint is recommended to keep your child's hand in an open position. This position is with fingers open and the thumb out of the palm, this is the opposite position of a fisted hand. Typically, it is recommended that a child wear this type of splint at night to provide a prolonged stretch for 6-8 hours. This can reduce the amount of stiffness as well as prevent the muscles from shortening. A resting hand splint can be beneficial even if your child's hand is not tightly fisted but still has some mild stiffness.
A weightbearing splint is recommended to allow your child to obtain weightbearing positions (i.e. crawling, side sitting). These positions will strengthen weak muscles as well as reduce the stiffness in muscles. This splint is most commonly recommended when an infant is learning to crawl. A weightbearing splint can be worn during therapy sessions to keep the infant's weaker hand in an open position and may or may not support the elbow depending on the child's level of weakness. This splint is also commonly recommended for older children who have limited movement in their hands but are working on strengthening shoulder and elbow muscles.
A thumb spica splint is recommended to allow a child to have a more successful and functional grasp. Often times a child's thumb may be weak and it is difficult for the child to hold it out of the palm. A thumb spica splint stabilizes the thumb outside of the palm so that the child can concentrate on moving his/her finger to pick up objects. A thumb spica splint can be made like the resting hand splint or the weightbearing splint with a hard plastic material or it can be ordered in a soft neoprene material.
A splint is of no use if it is not worn. It is very important that splints are worn according to the wearing schedule which has been specifically designed for your child. Children often do not want to wear the splint. It is important that a child is motivated and rewarded for wearing a splint. Proper use of a splint can prevent surgical intervention, facilitate improved functional use of the hand, and reduce breakdown of skin.
Splints may be made by Early Intervention therapists, outpatient therapists, or at the Children's Hospital of Philadelphia. Appropriate splints will be recommended when your child comes for his/her Stroke Clinic appointment and is evaluated by the therapists working with the stroke multi-disciplinary team. Always bring any splints that your child wears to your Clinic visit so they can be monitored for proper fit and function.