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Orthotic Management of Upper Extremity Deformity of a C5-C6 SCI Spastic Quadriplegic (A Case Report)
Mark D. DeHarde, President - Ultraflex Ststems, Inc. ®

Introduction
Spasticity in Quadriplegia and Encephalopathy is a result of pathologically increased muscle tone and primitive reflexes mediated by loss of inhibitory control.

Purpose
To report the effect of:

  1. Sub-maximal (below the stretch reflex) dynamic traction in the treatment of spastic flexor-induced deformity of the arm.
  2. Pronation assist on posture and function in forearm and hand.

Patient History

  • 20 year old male C5-C6 patient (status post 4/95) with complication of Encephalopathy in 7/97.
  • Spasticity induced postural elbow flexor/supination deformity worsened after the Encephalopathy.
  • Manual stretching, static splints and E-stim used 2 months prior to custom dynamic traction bracing did not improve deformity or function.

Treatment

  • Eight hours nightwear daily for both a custom made EWHO with elbow dynamic traction and pronation assist on right arm (dominant) and custom made EO with dynamic traction for left arm.
  • Adjustable joints also blocked out adverse elbow posture 20° sub-maximal to PROM.
  • Patient achieved approx. 8 hours wear daily through period 9/29/97 - 5/27/98.
Right arm with Ultraflex BraceLeft arm with Ultraflex brace










Measurement Table (Results)

Full extension and pronation = 0°
Numbers in table indicate° lacking from full ROM.

  9/27/97(initial) 1/20/98 5/27/98
Elbow Ext. (R) PROM -55° -31° -19°
Elbow Ext. (R) AROM -55° -45° -31°
Elbow Ext. (L) PROM -45° -30° -12°
Elbow Ext. (L) AROM -45° -43° -24°
Pronation (R) PROM -115° -85°
Pronation (R) AROM -115° -115° -115°*
*Patient can achieve full pronation position independantly through substitution and gravity to hold joystick, even though he lacks any pronation movement.

Before and After

Conclusion

  • Pronation was achieved resulting in self-feeding, improved ability mobility with joystick-controlled wheelchair and computer use.
  • Patient's elbow flexor and supination deformity was reduced.
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