Splints Used for Stroke Patients

Lower Limb Splints

1. Ankle-Foot Orthosis (AFO) - Most Common

• Inadequate dorsiflexion for heel contact or toe clearance during swing
• Excessive hip hiking during swing phase
• Mediolateral subtalar instability during stance
• Tibial instability during stance
• Uncontrolled foot placement due to sensory loss
• After operative heel cord lengthening

Three fabricated AFOs for ankle and knee control in a hemiparetic patient (Bradley and Daroff's Neurology, p. 1170)

Tip: If the hemiplegic knee buckles during stance, angling the AFO in slight plantar flexion helps prevent knee buckling by pushing the tibia forward and loading the quadriceps.

2. Knee-Ankle-Foot Orthosis (KAFO)

• Prevents knee snapping backward (genu recurvatum) in stance phase
• Also helps clear the foot and enable heel strike at end of swing
• Lightweight versions with locking metal knee joints are preferred

3. Metal Double-Upright Brace

• Offers greater rigidity for mediolateral foot instability
• More versatile adjustment for plantar/dorsiflexion
• Less preferred due to being heavier and cosmetically unappealing

Upper Limb Splints

1. Wrist-Hand Orthosis (WHO) / Resting Hand Splint

• Static type: solid wrist-hand splints set between neutral and 30° of wrist extension
• Placed on the volar (palm) side most commonly by occupational therapists
• Purpose: Prevent wrist and finger flexor contractures, maintain joint alignment, manage spasticity
• Note: Per Bradley and Daroff's Neurology, splinting to extend the wrist and long finger flexors is common practice in the first month after stroke, though randomized trials have not clearly shown it reduces wrist contracture alone without other modalities

• Functional position splint - wrist extended ~20-30°, fingers slightly flexed (most preferred clinically)
• Volar forearm-based wrist-hand splint - most widely used by OTs
• Wrist and finger extension splint - extends both wrist and fingers flat

2. Resting Hand Splint

• Maintains the hand in a resting functional position
• Controls spasticity-driven flexor posturing (clenched fist)
• Prevents maceration of the palm in a tightly clenched hand
• Often incorporates finger separators to reduce friction and pressure

3. Dynamic Splints (e.g., SaeboFlex)

• Compensate for inability to extend fingers or move the wrist
• Imitate the hand's natural grasp-and-release function
• Allow the patient to pick up and release objects during therapy
• Minimize joint damage and help fight contracture
• Used in occupational therapy and daily tasks

4. Functional/Supportive Wrist Splints

• Provide wrist stability to allow effective pinch and grip during tasks like handwriting or typing
• By making the hand functional, they also engage shoulder and arm muscles
• Prevent compensatory movement patterns where the patient avoids using the affected arm altogether

5. Lycra Arm Splints/Garments

• Tight-fitting compression garments made of Lycra
• Increase sensory and proprioceptive awareness through high-pressure contact
• Produce a mechanical compressive effect to improve movement quality
• Used as an adjunct to goal-directed arm training after stroke
• Evidence from Morris et al. (2019) supports feasibility in stroke rehabilitation

6. Shoulder Splints

• Address glenohumeral subluxation common in flaccid hemiplegia
• Slings and shoulder orthoses support the arm and prevent dependent traction on the joint

Summary Table

Key Clinical Points

• AFOs are started early during inpatient rehabilitation to assist foot clearance and speed up ambulation
• Static wrist splints are prescribed in the first month but should be combined with active therapy to be effective against contracture
• Dynamic splints are superior for functional recovery tasks compared to static resting splints
• Volar forearm-based wrist splints are the most commonly prescribed upper limb splint by occupational therapists in stroke
• Skin inspection is essential - pressure, shear, and heat retention must be monitored at all fittings