Knees and Elbows - Restorative Medical

Lost range of motion of patients’ joints is very common. Let’s look at knees and elbows. Did you know that we make slim and full versions of our standard sizes of the “Flex Elbow” and “Flex Knee?” We want you to provide the best fit for your patients.

Restorative Medical (RM) makes versions of these NeuroFlex® splints to address extension, hyperextension, and extensor tone. We also make these splints for below knee and below elbow amputee patients whose joints must be straightened so they can be fit with successful prosthetic limbs.

Whether from increased muscle tone or spasticity that has developed due to a neurological condition like cerebral palsy, traumatic brain injury/acquired brain injury, tumors, strokes or other brain conditions, torticollis, spinal cord injuries, whip lash injuries, spinal cord injuries, Parkinson’s disease, multiple sclerosis, dementia and end stage Alzheimer’s disease – or from immobility of sitting too many hours – those knees and elbows need to be addressed.

The length of the splint when treating lost range of motion – commonly referred to as “contracture” – is more important than the circumference. We need the appropriate leverage to be comfortable, to not present any potential pressure areas, and to do the best job at providing our Flex Technology stretch. RM’s splints provide a prolonged low load passive stretch but the difference in our splints and others is that ours move when the patient moves. They provide a bioengineered tension that is mild enough to not initiate a stretch reflex rebound effect that may result tissue shortening.

The body’s stretch reflex provides automatic regulation of skeletal muscle length. When a muscle lengthens, the muscle spindle is stretched, and its nerve activity increases. In health patients, this action is constantly working to keep us in an upright posture in a balancing act we have no idea is occurring. When we have damaged nerves, if a body part is stretched too far or too fast, a rebound effect may occur from the stretch reflex thereby holding the muscle in a shortened length. If the muscle is held in this length for long enough periods, it tends to shorten to this length.

This shortening was once considered to be “permanent,” but today we know that is not always the case and in almost all patients it can be improved, even if slightly, and prevented from worsening. The degree of relengthening may be influenced by the length of time it has been shortened, the amount of shortening, and the overall health of the patient. But that does not mean it may not be improved – and with vigilance some may even be corrected over a long enough time.

To do this work first we must first relax any increase in muscle tone, then a comfortable flexible prolonged low load passive stretch is applied (by the same Flex Technology splint) to realign the proteins in the muscle to prepare it to be relengthened. This is a PROCESS and it takes time and patience. In orthopedic rehab we plan for days and weeks and we look at just the injured joint or body part. In restorative rehab we start out talking about months and then years and we must consider the entire body. If we follow the restorative process, we work toward success. If we follow a more orthopedic plan for our neuro patients, we may see frustration, pain, and they may never reach their full potential.

Karen Lawson Bonn, RN, COF Clinical Specialist for Restorative Medical