In patients with muscular dystrophy, contractures usually occur as muscle breaks down. They begin at a very tender age of about 8 to 13. What this means is that muscles and tendons of the patient's wrists and hands tighten. Did you know that not all muscles lose strength at the same time?
Hand braces are devices that help increase the flexibility of the tendons and keep the muscles stretched, and perhaps slow down the deterioration of the muscles in the hands and wrists.
According to the United States National Library of Medicine and National Institute of Health Resources on Muscular Dystrophy, if an early clinical assessment of abnormalities and intervention techniques of the wrist and hand is put in place, it helps in the slowing of deforming process. Until recently, muscular dystrophy led to a life-threatening state around age 20, and fortunately, improved respiratory care has greatly helped in increasing life expectancy. This is wonderful, but we are still nowhere near where we need to be, and we must continue to fight for a cure. In the least, there are treatments and things patients can do to improve their condition. The hand brace is one of these things. It makes preserving the wrist and hand function a priority. Because of improvement in clinical research and rehabilitative interventions in children, we see that patients can have optimal health extending their life expectancy up to their 4th decade.
The disease has a predictable nature of complications first with the loss of muscle strength in the legs that puts them in a wheelchair around the age of 13 and later the muscles of the upper extremities begin losing their strength.
Clinical trial and research revelations
A particular study noted that a reduction in the muscle strength of your arms and hands consequently brings imbalances between your extensor and flexor muscles. The patient risks shortening of the muscles or joints leading to deformed hand or finger. Both extensor and flexor muscles are skeletal muscles which help in creating movements and burning calories. Flexors bend the joints whereas extensor extends and straightens the joints. By stretching and strengthening both muscles relieves you of the stiffness and soreness due to weakened muscles.
Clinical trials are in progress to see if in those who suffer from muscular dystrophy disorders, sleeping with hand braces would slow down the disease. In a specific research, eight boys with the disorder participated to test and discover if they could preserve hand function with the braces and potentially improve the boys’ quality of life. In that study, all the boys were given customized hand braces which they were to use while asleep. Next, they were to switch them from one hand to the other every other night.
These eight boys each had below 50 degrees of passive risk extension mobility. Before having the braces the boys were continually evaluated every month for between 6-12 months. When the braces were in use, the evaluation exercise continued for 8 months.
Amongst four of the participants, there was an indication that wrist extension was improved, while in the other four it was maintained in the dominant hand. A dominant hand is the one you prefer to use while eating, writing or grabbing items. Also, five participants experienced wrist extension in their non-dominant hand while two maintained but one had a decrement. Six of the boys had thumb abduction increases in their dominant hand, while the other two were persistently stable. The study also revealed that 5 boys increased thumb abduction in their non-dominant hand whereas the other three were persistently unchanged. And another thing, the boys' grip power and fine motor skills role exhibited some improvements.
In conclusion, the researchers believed that when a boy with DMD starts developing contractures in their long finger flexors, it is helpful to provide them with hand braces so as to delay muscular dystrophy effects on the hands.
Thanks to accelerated research, life expectancy of boys with muscular dystrophy has tremendously increased and many more boys reach adulthood and even have children. Good News! New research strategies on muscular dystrophy have not been limited to hand bracing, and plenty of it involves a wide range of therapies to help prolong the functional status of patients as long as possible.
Benefits of resting orthoses
The child’s hands are vital, complex and more importantly, versatile instruments that play a key role in their interaction with the environment. Any kind of impairment limits their ability to be individually independent. But here is something really interesting as an emergent field and research has given birth to a wide range of devices that DMD patients require for their daily assistance. A timely and early intervention improves the hand and wrist function. We found an array of benefits derived from sleeping with hand braces. These include:
- Dynamic orthoses are meant to overcome limitations like muscle weakness
- Improves quality of life
- Standardized care
- Braces improve grip strength
- Braces improve fine motor function example holding a crayon, turning pages in a book, removing own socks
When you combine the hand bracing with restorative rest at night, the hands will have full blood circulation improving the hand function and reinstate flexibility.
Challenges of the hand braces
- The hand braces are solutions still on experimental stages
- Patients have limited data on their efficacy
- Your occupational therapists need to take measurements of the boy’s wrist joint mobility regularly for doctors to decide when to begin using the hand braces
- The rest orthoses are customized so you don’t just pick from a drug store
- Cost implications are not known
The medical team to help implement bracing
A medical team is needed to help in formulating treatment plans for the patient to prepare for the braces. Besides, they should have procedures on how they intend to get the desired results. Experienced orthotists and physiotherapists are vital in choosing the best resting orthoses to help maximize the hand function.
- Pediatrician – A pediatrician will review any medical issues about the patient and coordinate the overall healthcare of the patient. Also, overseeing any medical issues in case of hospitalization.
- Orthotist – Works around preventing any imbalanced muscle groups which may lead to deformity of the patient as he or she grows.
- Physical therapist – Assists in designing monitoring and implementing a physical therapy program with the aim of reducing pain or restoring mobility.
Patients should not abandon other good rehabilitative programs for bracing, but rather explore various treatment options. Actually, the management of a DMD condition needs a multidisciplinary approach to focus on prevention and anticipatory measures in addition to active interventions in addressing the primary and secondary facets of the disease. Some of the trials are based on animal studies and have not been tested on humans and fewer studies published on bracing. Limited research has been carried out to determine whether sleeping with braces can actually slow down muscular dystrophy.
As much as there is no cure yet for muscular dystrophy, the role of research cannot be underestimated as it has helped in discovering helpful treatment options that slow down the effect of the disease. Finally, other methods like exercising and physical therapy involved in treating muscular dystrophy cannot be ignored. Why? Both help in avoiding stiffening of muscles that make it hard for the arms and hands to move.
- A particular study noted that a reduction in the muscle strength of your arms and hands consequently brings imbalances between your extensor and flexor muscles.
- When you combine hand bracing with restorative rest at night, the hands will have full blood circulation improving the hand function and reinstate flexibility.
- A medical team is needed to help in formulating treatment plans for the patient to prepare for the braces.