Skip to main content

Advertisement

SpringerLink
Log in

Upper Extremity Orthoses Use in Amyotrophic Lateral Sclerosis/Motor Neuron Disease: Three Case Reports

  • Published:
HAND

Abstract

Background

Central to the armamentarium of a hand therapist is evaluation for successful orthotic use. Orthoses can have a profound effect on quality of life in persons with amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND). The purposes of orthoses are to decrease the effects of muscle imbalance, provide assistance in performance of activities of daily living (ADLs), prevent joint contracture, and relieve pain. There are few published accounts on the usefulness of orthoses and ALS. The purpose of this paper is to expand the body of literature by describing three successful cases.

Methods

Three cases illustrate effects on weakened proximal muscles, wrist extensors, thenar musculature, and intrinsic muscles. The primary outcome measure is patient report, but functional rating scales, goniometry, quality of life scores, and pinch strength when obtainable are described.

Results

Due to the progressive nature of the disease, outcome measures can be inconclusive. Patient report of increased life satisfaction and ability to participate in daily life is the critical outcome in these case examples. In all cases, satisfaction increased. Some of the stated changes include the following: ability to manipulate objects, grip, eat, wipe face, hold phone, use iPad®, and adjust hat.

Conclusions

Upper extremity orthotic use can be a beneficial adjunct contributing to the quality of life for individuals with ALS/MND. We have observed positive responses in pain control, contracture management, functional positioning, and increased independence with the use of orthoses. Designing appropriate means of studying effects of orthosis intervention is deficient in the current scientific literature.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

References

  1. Campbell MJ, Enderby P. Management of motor neurone disease. J Neurol Sci. 1984;64:65–71.

    Article  CAS  PubMed  Google Scholar 

  2. Carswell A, McColl MA, Baptiste S, et al. The Canadian Occupational Performance Measure: a research and clinical literature review. Can J Occup Ther. 2004;71:210–22.

    Article  PubMed  Google Scholar 

  3. Cohen SR, Mount BM, Strobel MG, et al. The McGill Quality of Life Questionnaire: a measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability. Palliat Med. 1995;9:207–19.

    Article  CAS  Google Scholar 

  4. Dal Bello-Haas V, Kloos AD, Mitsumoto H. Physical therapy for a patient through six stages of amyotrophic lateral sclerosis. Phys Ther. 1998;78:1312–24.

    CAS  PubMed  Google Scholar 

  5. DeLisa JA, Mikulic MA, Miller RM, et al. Amyotrophic lateral sclerosis: comprehensive management. Am Fam Physician. 1979;19:137–42.

    CAS  PubMed  Google Scholar 

  6. Fetters L, Tilson J. Evidence based physical therapy. Philadelphia: F.A. Davis Company; 2012.

    Google Scholar 

  7. Francis K, Bach JR, DeLisa JA. Evaluation and rehabilitation of patients with adult motor neuron disease. Arch Phys Med Rehabil. 1999;80:951–63.

    Article  CAS  PubMed  Google Scholar 

  8. Goldberg A. Optimizing the skills of occupational therapists: an overview through a case study. Home Healthc Nurse. 2009;27:120–3.

    Article  PubMed  Google Scholar 

  9. Goldblatt D. Treatment of amyotrophic lateral sclerosis. Adv Neurol. 1977;17:265–83.

    CAS  PubMed  Google Scholar 

  10. Janiszewski DW, Caroscio JT, Wisham LH. Amyotrophic lateral sclerosis: a comprehensive rehabilitation approach. Arch Phys Med Rehabil. 1983;64:304–7.

    CAS  PubMed  Google Scholar 

  11. Law M, Baum C, Dunn W. Measuring occupational performance: supporting best practice in occupational therapy.  Thorofare: Slack Incorporated; 2005.

  12. Lenox AC. When motor nerves die. Am J Nurs. 1983;83:540–6.

    CAS  PubMed  Google Scholar 

  13. Lewis M, Rushanan S. The role of physical therapy and occupational therapy in the treatment of amyotrophic lateral sclerosis. NeuroRehabilitation. 2007;22:451–61.

    PubMed  Google Scholar 

  14. Maier A, Holm T, Wicks P, et al. Online assessment of ALS functional rating scale compares well to in-clinic evaluation: a prospective trial. Amyotroph Lateral Scler. 2012;13:210–6.

    Article  PubMed Central  PubMed  Google Scholar 

  15. McDonald CM. Limb contractures in progressive neuromuscular disease and the role of stretching, orthotics, and surgery. Phys Med Rehabil Clin N Am. 1998;9:187–211.

    CAS  PubMed  Google Scholar 

  16. Morris ME, Perry A, Bilney B, et al. Outcomes of physical therapy, speech pathology, and occupational therapy for people with motor neuron disease: a systematic review. Neurorehabil Neural Repair. 2006;20:424–34.

    Article  PubMed  Google Scholar 

  17. OCEBM Levels of Evidence Working Group*, * OCEBM Table of Evidence Working Group = Howick J, Chalmars L, (James Lind Library), Glasziou P, Greenhalgh T, Heneghan C, Liberati A, Moschetti I, Phillips B, Thornton H, Goddard O and Hodgkinson M. Levels of evidence table. In: Medicine OCfE-BM (ed); 2011.

  18. Pozza AM, Delamura MK, Ramirez C, et al. Physiotherapeutic conduct in amyotrophic lateral sclerosis. Sao Paulo Med J. 2006;124:350–4.

    Article  PubMed  Google Scholar 

  19. Rocha JA, Reis C, Simoes F, et al. Diagnostic investigation and multidisciplinary management in motor neuron disease. J Neurol. 2005;252:1435–47.

    Article  CAS  PubMed  Google Scholar 

  20. Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn’t. 1996. Clin Orthop. 2007;455:3–5.

    PubMed  Google Scholar 

  21. Sinaki M. Physical therapy and rehabilitation techniques for patients with amyotrophic lateral sclerosis. Adv Exp Med Biol. 1987;209:239–52.

    CAS  PubMed  Google Scholar 

  22. Sinaki M, Mulder DW. Rehabilitation techniques for patients with amyotrophic lateral sclerosis. Mayo Clin Proc. 1978;53:173–8.

    CAS  PubMed  Google Scholar 

  23. Smith RA, Norris Jr FH. Symptomatic care of patients with amyotrophic lateral sclerosis. Jama. 1975;234:715–7.

    Article  CAS  PubMed  Google Scholar 

  24. Tanaka K, Horaiya K, Akagi J, et al. Timely manner application of hand orthoses to patients with amyotrophic lateral sclerosis: a case report. Prosthet Orthot Int. 2013;0:1–4.

    Google Scholar 

  25. Tanaka K, Saura R, Houraiya K, et al. A simple and useful hand orthosis for patients with amyotrophic lateral sclerosis: a simple web spacer for thumb opposition weakness. Disabil Rehabil Assist Technol. 2009;4:364–6.

    Article  PubMed  Google Scholar 

  26. Willard HS, Spackman CS, Neistadt ME, et al. Willard and Spackman’s occupational therapy. Philadelphia: Lippincot; 1998.

  27. World Health Organization. International classification of functioning, disability, and health. Geneva: Author; 2001.

Download references

Conflict of Interest

Cindy C. Ivy declares that she has no conflict of interest.

Miranda M. Materi declares that she has no conflict of interest.

Susan M. Smith declares that she has no conflict of interest.

The authors have no conflict of interest or financial involvement with this manuscript.

Statement of Human and Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Statement of Informed Consent

Informed consent was obtained from all patients for being included in the study.

Author information

Authors and Affiliations

  1. Department of Physical Medicine & Rehabilitation, Mayo Clinic in Arizona, 5777 E. Mayo Boulevard, Phoenix, AZ, 85054, USA

    Cindy C. Ivy, Susan M. Smith & Miranda M. Materi

  2. School of Biological and Health Systems Engineering (SBHSE), Arizona State University, Tempe, AZ, USA

    Cindy C. Ivy

  3. AZ Hand Therapy, Mesa, AZ, USA

    Miranda M. Materi

Authors
  1. Cindy C. Ivy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susan M. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miranda M. Materi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cindy C. Ivy.

About this article

Cite this article

Ivy, C.C., Smith, S.M. & Materi, M.M. Upper Extremity Orthoses Use in Amyotrophic Lateral Sclerosis/Motor Neuron Disease: Three Case Reports. HAND 9, 543–550 (2014). https://doi.org/10.1007/s11552-014-9626-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11552-014-9626-x

Keywords

Search

Navigation