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Lycra orthoses and their use in MS

Liz Betts
Senior Physiotherapist, Newmarket Community Hospital

Way Ahead 2006;10(4):4-5

Introduction

Lycra orthoses have traditionally been used for the last ten years in the management of cerebral palsy, both to control spasticity and ataxia, and to improve posture and stability. Lycra orthoses are dynamic splints, which allow movement and can enhance functional activity. They are available as suits, gloves, sleeves, leggings, shorts and even socks.

There are currently three firms that produce lycra orthoses. However, the majority of my experience is with DM Orthotics (previously TYCO), which makes individually tailored garments to produce a close fit. It is believed that the increased pressure combined with the close fit, result in improved proprioception (sense of the position of parts of the body relative to other neighbouring parts of the body). The added layers of lycra produce resistance to add a biomechanical influence on the control of movement[1].

There are several studies demonstrating the effects of lycra on cerebral palsy, such as the Nicholson et al[2] study which looks at the effects of lycra suits on children with cerebral palsy with athetosis (a condition in which abnormal muscle contraction causes involuntary writhing movements), ataxia or spasticity. The results showed a general improvement in postural stability as well as an improvement in smoothness of movement in those with athetosis and ataxia.

Another study by Blair et al[3] also showed improvements in postural stability and involuntary movements, as well as increased confidence in carrying out motor tasks and improved dynamic function. These studies have tended to be long-term, using the attendance of children at school to both facilitate the donning and doffing of the garments, as well as study compliance.

In a study in 2000, Gracies et al[4] looked at the effect of lycra splinting on spasticity in stroke, particularly the effect on the upper limb. This study showed the effects of wearing lycra gloves over a period of three hours. Tests were performed before and during the wearing of the gloves. The study concluded that the splints have a positive effect on positioning and reduction of tone in the upper limb.

All these studies suggest that it should be possible to achieve comparable results in people with MS with similar symptoms. Ataxia and tremor are present in one third of people with MS, with ataxia being one of the most disabling symptoms[5]. In children it appears to be easy to achieve compliance in the use of the orthoses, particularly in those attending special schools where there is assistance and encouragement on hand. My feeling is that there is likely to be poorer compliance in adults for body suits, but that it may be possible to get good compliance for gloves, sleeves and socks.

Experience to date

I have been using lycra orthoses in clinical practice over the last 3-4 years. My first experience was with a girl, diagnosed with MS in her teens, who had ataxia in her left arm. She had been fitted with a lycra sleeve and gauntlet supplied by Second Skin whilst in the care of the paediatric service. It was necessary to evaluate the effect of these orthoses as she came into the adult service, partly due to cost. The client found that the Second Skin splints had stabilised the ataxia in her left arm, allowing her to feel 'more normal'. However, they had not had a significant impact on her function.

Before she was due to be reviewed by Second Skin, we arranged for her to try the DM Orthotics splints, to allow her to evaluate any difference in effect. Once fitted with the new orthoses, we asked the client what effects she had noticed in the 3-4 weeks of wearing the new orthoses. She reported an improvement in driving, having previously driven one-handed with a knob on the steering wheel. She was also able to carry items with both hands rather than one sided, but more surprisingly she reported that she was now able to put her earrings in, although she had to steady her elbow on the table. For this particular young lady the DM Orthotics orthoses have given her very good results. That is not to say that these orthotics are better than Second Skin, only that they suited this person.

Other people with ataxia who I have fitted with gloves and sleeves from DM Orthotics have reported improvements including:

  • better mouse control on the computer;
  • steadier eating and drinking; and
  • one client reported an improvement in writing skills.

However, use of the orthoses appears to be less beneficial in those clients whose ataxia is more severe and who have truncal involvement.

I have also had experience using the gloves and sleeves with people who have had a stroke and have increased tone in the upper limb. The results demonstrated improvements in the position of the arm and hand, with some clients reporting an improvement in function, including a significant improvement in the ability to play the piano in one case. I have also started to use socks in clinical practice to manage increased tone in the foot.

Research study to quantify the effects of DM Orthotics lycra orthoses

I am about to undertake a piece of research using a series of single case studies in people with a definite diagnosis of MS and ataxia in an effort to demonstrate quantifiable effects of DM Orthotics lycra orthoses. I shall use an ABA design* to obtain baseline measurements and then assess the effect of the orthoses on and then off. Each time frame will be two weeks. This study design should also indicate whether there are any carryover effects in the period immediately following the intervention.

Each client will be assessed according to the International Cooperative Ataxia Rating Scale (ICARS)[6]. This may enable us to see if the level of disability or severity of ataxia will influence the effect of the orthoses. Testing will be done using the Nine Hole Peg Test[7], the Motor Assessment Scale[8], as well as the Spiral Writing Test (taken from ICARS). Each subject will be asked to fill in a health status questionnaire[9] at the beginning and end of the intervention to evaluate the effect on the clients self esteem and quality of life.

Clinical practice indicates that this type of intervention may have a positive effect on function and smoothing out of movement. All types of lycra orthoses could become useful tools to help manage what is a very difficult symptom, which can have devastating effects on daily living. Hardie[10] reported that chronic ataxia might cause people to become "unnecessarily inactive and dependent".

Traditional treatments for ataxia include the use of resistance, weights[11,12] and pressure splints[13]. Lycra orthoses use resistance and pressure; the resistance should have the same effect as weight therapy in smoothing out the movement and thus making it more functional.

I believe this is an area that needs to be researched further. Potentially it could enable effective management of a very difficult and disabling symptom. I would be interested to hear of other people's experiences in this relatively new area of development, email: liz.betts@talk21.com

* ABA refers to a specific type of research design in which you have a baseline period where no treatment is given and/or no variable is introduced (A), followed by a period in which the treatment or variable is introduced (B), and then a period in which the treatment is removed so the behaviour can be observed a second time (A). This way you can measure behaviour before treatment, during treatment, and once treatment is removed.

References

  1. Dynamic Lycra Orthoses information leaflet, 2003.
  2. Nicholson JH, Morton RE, Attfield S, Rennie D.
    Assessment of upper-limb function and movement in children with cerebral palsy wearing lycra garments.
    Dev Med Child Neurol 2001; 43(6): 384-391.
  3. Blair E, Ballantyne J, Horsman S, Chauvel P.
    A study of a dynamic proximal stability splint in the management of children with cerebral palsy.
    Dev Med Child Neurol 1995; 37(6): 544-554.
  4. Gracies JM, Marosszeky JE, Renton R, et al.
    Short -term effects of dynamic lycra splints on upper limb in hemiplegic patients.
    Arch Phys Med Rehabil 2000;81(12): 1547-1555.
  5. Management of ataxia and tremor.
    Medical Physics Multiple Sclerosis Research Unit; 2004.
    Available from www.bris.ac.uk/Depts/Medphys/ms2.html
  6. Trouillas P, Takayanagi T, Hallett M, et al.
    International Cooperative Ataxia Rating Scale for pharmacological assessment of the cerebellar syndrome.
    J Neurol Sci 1997; 145(2); 205-211.
  7. Wade D.
    Assessment of motor function: impairment and disability.
    In: Greenwood R, Barnes M, McMillan TM, Ward CD, editors.
    Neurological Rehabilitation.
    Hove: Psychology Press; 1997.
  8. Carr JH, Shepherd RB, Nordholm L, Lynne D.
    Investigation of a new motor assessment scale for stroke patients.
    Phys Ther 1985; 65(2): 175-180.
  9. Ware JE.
    SF-36 Health Survey: manual and interpretation guide.
    Boston: Nimrod Press; 1993.
  10. Hardie R.
    Tremor and Ataxia.
    In: Greenwood R, Barnes M, McMillan TM, Ward CD, editors.
    Neurological Rehabilitation.
    Hove: Psychology Press; 1997.
  11. Thornton H, Kilbride C.
    Management of abnormal tone and movement.
    In: Stokes M, editor.
    Neurological Physiotherapy.
    London: Mosby; 1998.
  12. Carr JH, Shepherd RB.
    Neurological rehabilitation: optimising motor performance.
    Oxford: Butterworth-Heinemann; 1998.
  13. Johnstone M.
    Restoration of normal movement after stroke.
    Edinburgh:Churchill Livingstone; 1995.

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