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Background and aim: Ankle plantar flexor is one of the most susceptible muscles to plasticity and contracture after acquired brain injury. The application of thermal agents was introduced before muscle stretch or active exercises in spastic patients for their relaxation effects. The main aim of the present study was to compare the short-term effect of the ultrasound (US) and infrared (IR) on patients with plantar flexor muscle spasticity.

Materials and Methods: 21 patients were randomly allocated placed to either US(n=11)or IR(n=10)groups. The main outcome measures were, H _max / M _max  ratio, Original Ashworth Scale(OAS), active and passive range of motion (ROM).These tests  performed before, immediately after and 15 minutes after the intervention.

Results: There were no significant changes in H _max / M _max ratio and OAS after the intervention in both groups. The significant changes of the H _max / M _max were observed 15 minutes after intervention in the US group .The change in OAS was also statistical significant in IR group in this period. The changes in active and passive ankle dorsiflexion ROM after the intervention were statistically significant in US group. These changes show the significant changes for ankle passive ROM after15 minutes of  the intervention in IR group.

Conclusion: Our findings demonstrate that one session application of the ultrasound and infrared are not effective in the treatment of muscle spasticity. The ultrasound improved the ankle active and passive ROM. Further research is needed.

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Background and aim: Spasticity cause abnormal patterns in upper limbs of cerebral palsy children .It restricts hand function in grasp and release movement. In occupational therapy, neurophysiologic approaches include motor techniques, training and treatment for decreasing hypertonicity and biomechanical approach includes use of splint. In present study the effects of volar and dorsal splint were determined in decreasing of spasticity in upper limbs of quadriplegia cerebral palsy children with four up to six years old

Materials and methods: Twenty quadriplegia spastic children (4-6 years old) were participated in this study. They were classified in two groups. One group wears volar splint and the other group wears dorsal splint for two hours per days and four hours at night up to twelve weeks. Spasticity and passive range of motion were measured by modified  Ashworth scale and goniometry respectively

Results: The mean of wrist spasticity was 2.5 in volar splint group before intervention and 1.9 after intervention. The mean of wrist passive range of motion was 93.50 before intervention and 123.50 after intervention. Elbow passive range of motion was 113 in pre intervention and 135.50 in post intervention. The mean of wrist spasticity was 2.6 in dorsal splint group before intervention and 2.00 after intervention. The mean of wrist passive range of motion was 89.5 before intervention and 118.50 after intervention. Elbow passive range of motion was 110.50 in pre intervention and 135.50 in post intervention. Statistical Analysis of t-student and paired t-tests showed significant differences between the pre and post intervention in all parameters (p<0.05)

Conclusion:  The result of present study showed that both of the splints affected to decrease spasticity of wrist and increase wrist and elbow passive range of motion of hand. Based on this evidence, both of the splints would be suggested for spastic`s hand treatment. Due to major problem in making dorsal splint, we suggest volar splint for  reducing  spasticity in cerebral palsy children.

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Background and aim: The most prominent problems that is produced after stroke are spasticity or increase in muscle tone, decrease in range of motion and function of upper extremity. The aim of this study was to determine the effects of Volar-Dorsal Wrist/Hand Immobilization Splint on function of upper extremity, range of motion of  the elbow, wrist and metacarpophalengeal joints and spasticity of the elbow and wrist joints.

Material and methods: Fourteen patients were participated in these experiments. The patients were selected according to inclusion and exclusion criteria and they had been given the splint after primary evaluation and were reevaluated after one month. Spasticity were evaluated with Modified Ashworth Scale.Range of motion were measured by goniometer. Fugl-meyer test were used to assess function of upper extremity. The splints were used 2 hours daily and whole night (6-8 hours) in one month.

Results: Comparison of data before and aft er the experiment showed significant mprovement in upper extremity function (P=0.04). Range of motion and spasticity were not significant (P>0.05).

Conclusion: Volar-Dorsal Wrist/Hand Immobilization Splint can improve the function of upper extremity. Although spasticity and range of motion showed a little changes in short-term use (1month) but the differences were not significant that will need more studies.

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Background and Aim: Cerebral palsy is a non progressive disorder and the most common movement problem in children. Many children with cerebral palsy are of hemiplegic type. One of the important problems of this children is unilateral upper limb dysfunction, that not using the affected side causes forgetfulness and more problems on this side. In this study, effectiveness of Constraint-Induced Therapy(CIT) and the maintainance of this technique on spasticity and performance of upper extremity in hemiplegic cerebral palsy children 6 to 12 years old have been investigated. 

Materials & Methods: In this pretest - posttest quasi experimental study, 20 cerebral palsy hemiplegic children 6 to 12 years old (15 boys and 5 girls) with  8.7   years mean age were selected. Interventions were performed about 8 weeks and patients were followed for 4 weeks. Spasticity on the affected side in wrist and elbow were tested by Modified Ashworth Scale and upper extremity function by the Box & Block test. The data were analyzed with the Wilcoxon and paired t- tests.

Results: Constraint-Induced Therapy in the affected limb decreases significantly the spasticity of wrist (p = 0.00) and elbow (p = 0.005) and significantly increases performance score (p = 0.00), and the recovery significantly maintained one month after the interventions.

 conclusion: Constraint-Induced Therapy of affected upper extremity could possibly decrease limb spasticity and increase function with two mechanisms: Fierstly, The reduction of not using the plegic side and secondly, neuroplasticity in CNS. This improvement may remain viable in the affected limb. 

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Background and Aim: Upper limb dysfunction is a common and disabling consequence of cerebral palsy. Any functional disorder in the hand can cause a person's independence to be disrupted and therefore his or her social independence is threatened. The purpose of this study was to determine the effects of volar static splint on hand function, spasticity and wrist and elbow range of motion of 8 to 12 years old spastic children.
Materials and methods: The design of this study was clinical trial and before_ after. Fourteen 8 to 12 spastic cerebral palsy children that have the inclusion criteria of study were selected from rehabilitation clinics of Tehran. The patient used a volar static splint (10 degree of wrist extension, full extension of fingers and abduction and opposition of thumb) for 2 mounts (2 hours during day and 4 to 6 hours at night). In this study Jebsen Taylor Hand Function Test was used to evaluate hand function. Modified Ashworth Scale was used to evaluate spasticity. A Goniometer was used to measure range of motion.
Results: The results of this study showed significant improvement in hand function  ,significant reduction in wrist spasticity  and elbow spasticity  and significant increase in wrist range of motion The data did not show any significance in elbow range of motion .
Conclusion: Our findings suggested that 2 months using of volar static splint in children with spastic cerebral palsy can improve hand function, wrist and elbow spasticity and wrist range of motion.

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 Background and Aim: Spasticity is a motor disorder characterized by a velocity dependent increase in tonic stretch reflex and tendon jerks, due to the hyper-excitability of the stretch reflex. Modified Tardieu Scale (MTS) is a clinical tool for assessment of spasticity. The purpose of this study was to investigate intra-rater reliability of the MTS for knee extensors and ankle plantar flexors muscles in adult subjects with chronic stroke.

 Materials and Methods: In an analytical cross sectional study, 17 participants (10 men ,7 women) with age range of 40-76 years and mean time post stroke of 20/79 (SD=20/55) in a convenient sampling took part in this test-retest study. Intra-rater reliability of spasticity with MTS was investigated by one un-experienced physiotherapist for knee extensors and ankle plantar flexors in two sessions over one week. 

 Results: Interclass correlation coefficient (ICC) values for R₂-R₁ as an indicator of spasticity in knee extensor and plantar flexors was good (ICC=0/66) and very good (ICC=0/87) and for knee extensors and ankle plantar flexors quality of muscle reaction was 0.80 and 0.92 respectively.

 Conclusion: The MTS has a good reliability in spasticity assessment of knee extensors and ankle plantar muscles after stroke. Probably MTS can be used as a reliable clinical tool to measure spasticity of lower extremity muscles in adult subjects with chronic stroke.

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Background and Aim: Spasticity is one of the symptoms that contributes to functional limitation in adults with cerebral palsy and characterized by a velocity dependent increase in tonic reflex due to the hyperexcitability of the stretch reflex. Modified Tardieu Scale (MTS) is a valid clinical tool for assessment of spasticity. The purpose of this study was to investigate Inter-rater reliability of the Modified Tardieu Scale (MTS) for hip adductors, knee extensors and ankle plantar flexors muscles in adult subjects with cerebral palsy.

 Materials and Methods: In an analytical cross sectional study, 30participants (11 men ،21 women, age range 20 to 40 years, mean age (26.57±4.8) with spastic cerebral palsy from Ra'ad Rehabilitation Goodwill Complexes in Tehran city in a convenient sampling took part in this study. Spasticity was measured by two physiotherapist for hip adductors, knee extensors and ankle plantar flexors with MTS during same session with ten minutes interval between assessment of two raters.

 Results: ICC values for R₂-R₁ as an indicator of spasticity in hip adductors, knee extensor and plantar flexors were 0.97, 0.88 and 0.81 respectively. Also ICC Values for quality of muscle reaction was 0.89 in hip adductors, 0.96 in knee extensors and 0.92 in ankle plantar flexors

Conclusion: MTS has a high reliability in spasticity assessment of adductors, knee extensors and ankle plantar flexors muscles, Probably MTS can be used as a reliable clinical tool to measure spasticity of lower extremity muscles in adult subjects with cerebral palsy.

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Background and Aim: Cerebral Palsy (CP) children are the most clients referred to occupational therapy settings. Hand function is important in Activities of Daily living .There is a hand dysfunction in most cerebral palsy children. Orthosis and splints are commonly used to improve the position, range of motion, quality of movement and function of a person's arm or hand. The aim of this study was to investigate the effects of static cock up c-bar splint on strength,spasticity, range of motion, and dominant hand function in spastic diplegic children with 8 to 12 years old. 

Materials and Methods: This interventional study is in a before-after design. Thirteen spastic diplegic cerebral palsy children with 8 to 12 years old were selected through students who studied in physical disabled schools in Tehran city and had the inclusion criteria. Patients used a static cock up c-bar splint (wrist in 10 degrees of extension and thumb in palmar abduction and opposition) for two months, 2 hours daily and 4-6 hours at night. In this study the Jebsen Taylor test was used to evaluate hand function, the Modified Ashworth Scale was used to assess spasticity of thumb, wrist and elbow, ROM of thumb, wrist and elbow were tested with goniometer and power grip was evaluated with dynamometer.  

 Results : Results showed a significant improvement in hand function (p<0.001), in wrist`s spasticity (p<0.001), elbow`s spasticity(p<0.008), palmar abduction of thumb spasticity (p<0.002), wrist`s ROM (p<0.001), Palmar abduction of thumb ROM(p<0.001) and power grip(p<0.001). The data did not show significant improvement on elbow`s joint ROM. 

Conclusion: Information from present research shows that using static cock up c-bar splint for 2 months, 2 hours a day and 4 to 6 hours nightly, can be an effective method to improve power grip, hand function, thumb, wrist and elbow spasticity and range of motion of thumb and wrist of spastic diplegic CP children.

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Background and Aim : Cerebral palsy (CP) children are the most referral patients to occupational therapy centers. Hand function is important in activity of daily living. There is a hand dysfunction in most cerebral palsy children. Orthosis and splint are commonly used to improve the position , range of motion, quality of movement, arm and hand function. The aim of this study was to investigate the effects of static anti-pronation splint on dominant upper extremity function in spastic diplegic cerebral palsy children with 8 to 12 years old.

  

Materials and Methods : This interventional study is in a before-after design for two group case and control. Thirty spastic diplegic cerebral palsy children with 8 to 12 years old who had the inclusion criteria, were randomly assigned to case and control group. Patients of case group used a static anti-pronation splint for 2 months, 8 hours daily. In this study the Jebsen Taylor test was used to evaluate upper extremity function, the Goniometer was used to measure ROM of elbow, forearm and wrist, the Modified Ashworth Scale was used to assess spasticity of elbow, forearm and wrist. Power grip and pinch were assessed with MIE device.

  

Results : In the case group results showed a significant improvement in upper extremity function (0.026), forearm supination ROM (0.007), wrist extention ROM (0.005), forearm muscle pronator spasticity (0.001), wrist muscle flexsor spasticity (0.009), power grip (0.001) and pinch (0.001). The data did not show significant improvement on elbow extention ROM (0.075), elbow muscle flexsor spasticity (0.164). In comparison with control group, the data showed a significant improvement in upper extremity function (P=0.001), forearm supination ROM (p=0.034), wrist extention ROM (P=0.042), forearm muscle pronator spasticity (P=0.009), power grip (P=0.001) and pinch (P=0.001). The data did not show significant improvement on elbow extention ROM (P=0.140), elbow muscle flexsor spasticity (P=0.638) and wrist muscle flexsor spasticity (P=0.105).

  

Conclusion : The findings show that using static anti-pronation splint for 2 months , 8 hours a day , can be an effective method to improve upper extremity function , range of motion of forearm and wrist , forearm spasticity and power grip and pinch in spastic diplegic cerebral palsy children with 8 to 12 years old .

  

Key word : Cerebral palsy, Static anti pronation splint, Upper extremity function, Spasticity, Power