Upper Limb Orthoses for the Stroke- and Brain-Injured Patient

Abstract Stroke and brain injury are often complicated by the development of upper motor neuron syndrome. Most spontaneous motor recovery occurs within 6 months of stroke and traumatic brain injury. Combining the therapeutic interventions of oral antispasmodics, therapy, casting, bracing, and targeted chemodenervation is a first-line measure. Definitive surgical procedures to reduce spasticity are effective and include neurectomies, tendon releases, and transfers. It is important to treat the underlying spasticity to use orthoses effectively. The prolonged period of spontaneous neurologic recovery is complicated by spasticity (resistance to quick stretch), rigidity (resistance to slow stretch), impairment of motor control, synergistic patterns of movement, synkinesis (involuntary associated movement in a distant limb segment), and immobility. Orthotic selection heavily depends on the patient's realistic functional goals as well as the severity, type, and distribution of joint range of motion impairment. It is a compromise of immobilization versus function meant to restore normative biomechanics to the upper limb.