International Journal of Physical Medicine & Rehabilitation
Open Access

Abstract

Upper Extremity Orthoses Use in Amyotrophic Lateral Sclerosis/Motor Neuron Disease: A Systematic Review

Cynthia Clare Ivy, Susan M Smith and Miranda M Materi

Background: Orthoses decrease the effects of muscle imbalance, provide greater ease in performance of activities of daily living, prevent joint contracture, and relieve pain. There are no published systematic reviews on the use of upper extremity (UE) orthoses in amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND).

Objective: The aim of this systematic review is to determine common orthosis interventions for ALS/MND.

Methods: The authors performed a systematic review of the literature available on Medline, EMBASE, Google Scholar, PubMed, the Cochrane Database of Systematic Reviews, and CINAHL. Key words used: 1) ALS, amyotrophic lateral sclerosis, Lou Gehrig’s disease, MND, motor neuron disease; 2) OT, occupational therapy, hand therapy, PT, physical therapy; 3) splint, brace, orthosis, orthoses, orthotic, orthotic device. Three reviewers critically appraised 22 articles using a standard format.

Results: The reviewers identified no randomized controlled or controlled clinical trials, five level 4 (case reports) and seventeen level 5 (expert opinions) using Sackett’s original 5 level pyramid.

Conclusions: Patients with ALS demonstrated improved function, increased range of motion and decreased pain with orthoses. However, there were few studies that met the search criteria. Furthermore, the studies that were reviewed had limited subjects, making it difficult to draw definitive conclusions. Further research is needed to determine appropriate study designs. for the use of upper extremity orthoses in ALS/MND. Prospective studies would strengthen the results.