Splints after stroke, brain injury or with cerebral palsy are mostly about POSITIONING, especially when tone is high (tightening of the muscles which tends to pull affected limbs into flexion).
High tone pulls the wrist down, the fingers into a fist and the thumb into the palm, and holds them there. A positioning splint supports the hand in the most open position that tone allows at rest, without fighting it.
The aims are practical:
- keep the palm clean and the skin intact,
- keep the hand comfortable,
- maintain the muscle length and joint range you have, and
- make washing, dressing and care easier
Function is a bonus in some hands – positioning is the main job.
What high tone does to a resting hand
- The muscles that bend the wrist, fingers and thumb are overactive, and the ones that open the hand can’t counter them
- Left unsupported, the hand spends hours a day, and all night, in a tight fist with the wrist flexed
- Muscles held short for long enough can shorten, and joints can lose range
- A closed palm traps moisture. Skin softens, breaks down and can become infected, and nails dig in
- A tight hand is harder to wash, dress and position, for the person and for carers
With high tone, the splint isn’t there to force the hand open. It’s there to hold the hand in the best position it can comfortably keep.
Positioning principles
- Work within the range tone allows. The splint holds a gentle, sustained stretch, not end range. Pushing to full range tends to trigger more tone, pain and pressure problems
- Wrist supported, typically near neutral or slightly extended, as tolerated
- Fingers supported in extension, sometimes with spacers between them to spread the hand and ease the grip reflex
- Thumb held out of the palm, so the web space stays open and the thumb isn’t trapped under the fingers
- Fit at the calmest moment. Tone is usually lower after slow, gentle stretching and in relaxed, warm positions. That’s when the splint goes on
- Less open is better than not tolerated. A splint the hand fights all night does more harm than a slightly less ambitious one that stays on comfortably
The main positioning splints
- Resting or positioning hand splint: palm-side support for the wrist, fingers and thumb, the mainstay for rest and night. See resting hand splints
- Splints with finger spacers: the fingers held apart as well as supported, which some hands with strong grip tone tolerate better
- Palm protector or cone: a soft roll or cone in the palm to keep it clean, dry and open when a full splint isn’t tolerated
- Thumb abduction splint: soft or rigid, holding the thumb out of the palm. Common in children with cerebral palsy. See first web space splints
- Serial casting: for range that’s already being lost, often timed with botulinum toxin injections to hold the extra range while the muscles are relaxed. See serial casting
How it fits into the day
- Rest periods and night, where the hand is otherwise unsupported for the longest
- Built up gradually, starting with shorter periods and checking the skin each time
- Alongside positioning of the whole arm in bed and in the chair, so the shoulder, elbow and forearm aren’t pulling the hand back into a fist
- With daily slow stretching and hand hygiene, done before the splint goes on
- Reviewed as tone changes. Tone can increase or settle over months, and medication or injections change it too
A splint on its own hasn’t been shown to reliably prevent contracture or reduce spasticity. It works as one part of a positioning, stretching and care plan.
Extra care that matters
- Sensation may be reduced, so pressure sores can develop without pain. Check the skin every time the splint comes off
- Communication may be limited. Carers need to watch for redness, swelling, restlessness or distress
- Tone changes through the day, so a splint that fits at bedtime may press by morning
- Ease the hand into the splint slowly, never force it. If it fights the splint every time, the position needs revising
Get it reviewed if
- Red marks that last more than 30 minutes after removal
- Skin breaking down in the palm, between the fingers or over bony points
- The hand becoming tighter despite the prograe
- The splint causing pain, restlessness or disturbed sleep
- A child outgrowing the splint
This site focuses on hand, wrist and elbow injuries and conditions. Neurological hand care is usually managed by a stroke, brain injury or pediatric team, with a hand or occupational therapist designing and making the splints.
This is one of dozens of splints a hand therapist makes. See what a hand therapist does for the full list.
With high tone, position the hand within what it allows, protect the skin, and keep the plan bigger than the splint.
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.