FEBRUARY 1981
Checklist for the Prescription of Slings for the Hemiplegic Patient
Roger O. Smith and Gary A. Okamoto
The American Journal of Occupational Therapy (Volume 35, No.2)
ABSTRACT
The wide variety of hemiplegic sling designs, the lack of a uniform approach to sling selection, and the paucity of research data in this area have tended to make prescribing a sling a subjective process. Based on clinical experience and a comprehensive literature review, the authors propose a checklist for examining hemiplegic slings. The Checklist, which includes 19 desirable and 4 undesirable characteristics of slings, provides a more objective basis for comparing sling designs, warns of potential hazards, and facilitates the thorough examination of hemiplegic slings. The uses and limitations of the Checklist are discussed.
To read the article online,
please click here.
How does the GivMohr Sling compare with the
Checklist? Click here for the answer.
DECEMBER 2005
Comparative Effectiveness of the GivMohr Sling in Subjects With Flaccid Upper
Limbs on Subluxation Through Radiologic Analysis
Archives of Physical Medicine and Rehabilitation
(Volume 86, Issue 12)
The purpose of the study was to compare the effectiveness of the GivMohr sling
in reducing subluxation while providing joint compression through a flaccid
limb, using the criterion standard of radiography for measuring subluxation.
Twenty-five adult volunteers with a flaccid upper limb (UL) secondary to
cerebrovascular accident or other pathology participated in the study, which was
conducted by the University of New Mexico, Health Sciences Center, Physical
Therapy Program.
The results of the study revealed a significant main effect for vertical but not
horizontal subluxation. Post hoc tests showed that the GivMohr sling measures
were similar to measures for the uninvolved shoulder.
The study authors concluded that a properly fitted GivMohr sling reduces
subluxation without overcorrecting and provides an alternative treatment option
for persons with flaccid ULs that may prevent secondary complications and
improve outcomes.
For your convenience, you may view and print a summary of the study
or read and print the full study article.
REVIEW OF PILOT STUDIES OF THE GIVMOHR SLING
Cerebral vascular accident (CVA) is a devastating event that brings with
it a wide variety of impairments. The deficits arising from even a small CVA
can affect every system in the body. Physically, the most noticeable system
affected is the musculoskeletal system. Following CVA, the muscles of the
involved side have the daunting task of functioning with an altered nervous
system. Rehabilitation is often frustrating and functional returns may be
minimal. Nowhere is this seen or felt more than in the upper extremity.
A flaccid or low tone upper extremity is a common finding in individuals
following a CVA, and its rehabilitation is crucial in the recovery process.
A flaccid upper extremity presents a challenge to the treating therapist
because the protection necessary for the extremity involved often hinders its
functional return.
Upper extremity positioning and slings are often used to protect the upper
extremity. There are several different ambulatory upper extremity supports
used in stroke rehabilitation. All of these slings are designed to support
the arm, but few actually reduce subluxation and none of them support the arm
in a functional position. Therefore support of the hemiplegic limb while in
the upright position remains controversial.
It is hypothesized that early, proper support of the flaccid upper
extremity leads to decreased subluxation, increased potential for motor
return, and improved balance and upright mobility skills. With this
in mind, the GIVMOHR SLING was created and developed by Vicky Givler,
OTR/L and Paul Mohr, PT over a period of three years. This sling supports
the upper extremity in a functional position, reduces shoulder subluxation
and provides weight-bearing through the involved side to increase proprioception
and normalize tone. This support provided by the GivMohr Sling allows
for improved movement quality and increased function. The sling is to
be used in upright activities including walking.
Three small pilot case studies have been conducted with the GIVMOHR
SLING at the University of New Mexico, Department of Physical Therapy
under the supervision and direction of Assistant Professor Kathy Dieruf,
PhD, PT, NCS.
RADIOGRAPHIC ANALYSIS
The second research project was done at the University of New Mexico,
Physical Therapy Department by Erin Joerg, PT student and Kathy Dieruf,
PhD. PT, NCS on the effects of the GIVMOHR on reducing both horizontal
and vertical subluxation- GivMohr Radiographic Analysis. The study reviewed
types of slings available and what were the ideal characteristics of
slings to support the flaccid upper extremity. It was found that the
"incidence of subluxation in CVA survivors varies from 12%-73%." It
was also emphasized that if shoulder subluxation was left untreated
that complications such as distension of the capsule, stretching of
surrounding musculature, limited mobility, shoulder hand syndrome, subacromial
impingement, interference with functional activities, and impairing
return of upper limb function. Use of slings may prevent these injuries.
A study by Smith presents the "Checklist for Prescription of Slings"
which
includes proper positioning of the humeral head in the glenoid fossa,
some humeral abduction, external rotation, elbow extension, neutral
wrist, unobstructed hand function, abduction of fingers, encouragement
of scapular depression and retraction. Comfort, cosmetic appeal, snug
fit without skin break down and the capacity to permit active or passive
ROM."
Three anterior/posterior view radiographs were taken of three individuals
with a flaccid upper extremity; without the GIVMOHR sling, with the
GIVMOHR sling, and the uninvolved shoulder. The study found that the
GIVMOHR sling reduced subluxation in addition to it other functions.
The study concluded that the GIVMOHR sling meets the criteria on the
"Checklist for Prescription of Slings". It also provides forearm support,
and was successful in decreasing subluxation vertically and horizontally
without overcorrecting. The sling is successful by the above criteria
and promotes weight bearing in anatomical and functional positions.
GAIT ANALYSIS
The second research project by William Dunbar, PT was a study to determine
the effects of the GIVMOHR upper extremity weight bearing sling on the
gait of post CVA patients with flaccid upper extremities. Dunbar concluded
that a "statistically significant increase in the step length of the
non-hemiplegic side on the subject who wore a sling. It may be hypothesized
that because of the GivMohr upper extremity weight bearing sling the
subject was able to spend more time in stance phase on the involved
side thus increasing the step length of the uninvolved side. The natural
position of the upper extremity provided by the sling enables the patient
to move in a more normal pattern during upright activities. Allowing
the upper extremity its normal position during gait keeps the center
of mass centered over the base of support which is required for optimum
balance."(1)
FUNCTIONAL ANALYSIS
The third project was a study on The Effects of the GivMohr Upper
Extremity Weight Bearing Sling on Function Following Stroke conducted by
Melissa L. Appel, PT and Kathy Dieruf, PhD, PT, NCS at the University of New
Mexico, Physical Therapy Department. "The purpose of this pilot study was to
determine the effectiveness of a custom-made upper extremity sling, the
GIVMOHR sling, on return of functional activity. The measurement tools used
were the Functional Independence Measure and the Fugl-Meyer Assessment. Four
subject who had sustained a CVA within the past year participated in the
study. All subjects were admitted to a local rehabilitation facility and had
a flaccid upper extremity. Subjects were place in either a sling or
non-sling group and all subjects received standard therapy using
Neuro-Developmental Treatment technique. Pre and Post-test measures of
functional abilities were conducted at 2-week intervals. Subjects wearing the
sling improved their UE function, locomotion, and self-care skills while
subjects without the sling showed no UE improvement." The study concluded
that "the GIVMOHR sling may lead to greater and more timely functional
recovery of the flaccid UE, but due to the limited sample size further study
is recommended."(3)
In conclusion, based on the results of pilot studies at UNM, the GIVMOHR
sling reduces shoulder subluxation, increases stance time on the hemiplegic
side thus increasing the step length and may lead to greater and more
timely functional recovery. The above studies are being continued to
develop larger sample sizes to improve reliability. For more information
on complete studies. E-Mail:
Professor Kathy Dieruf PhD, PT, NCS (Kdieruf@Salud.unm.edu)
- Dunbar, William, PT, and Kathy Dieruf,
PhD, PT, NCS. The GivMohr and
Gait. University of New Mexico, Physical Therapy Department, 1999.
- Joerg, Erin, PTS, and Kathy Dieruf, PhD, NCS. GivMohr Radiographic
Analysis. University of New Mexico, Physical Therapy Department. 2000.
- Appel, Melissa, PT, and Kathy Dieruf, PhD, NCS. The Effects of the
GivMohr Upper Extremity Weight Bearing Sling on Function Following Stroke.
March 2012
The Effect of the GivMohr Sling on Gait Parameters Post Stroke
Kathy Dieruf, PR, PhD, NCS, Jerimiah MacDonald, SPT and Luke Myers, SPT
University of New Mexico
This study conducted at the University of New Mexico offers valuable information about how the GivMohr Sling can help to normalize gait and improve velocity. This study is not yet published, but was presented at the Physical Therapy Combined Sectionals, Chicago,
March 2012. Please click here to read the presentation summary.
October 2013
Clinical Reasoning in the use of Slings for Patients with Shoulder Subluxation After Stroke: A Glimpse of the Practice Phenomenon in California
Kitsum Li, Naoko Murai, Simon Chi
Dominican University of California
Occupational therapists frequently use shoulder slings
for the management of post-stroke shoulder subluxation despite the low
evidence for its efficacy. One hundred and sixty-eight Occupational
Therapists in California responded to a survey regarding the occurrences
and clinical reasoning in the use of shoulder sling with patients post
stroke.
The survey was designed to answer 4 primary questions:
- What is the occurrence of the use of shoulder
sling in the post-stroke occupational
therapy practice across the
clinical settings? - What is the clinical reasoning for using the
shoulder sling?
- What types of sling are commonly used in the
post-stroke occupational therapy practice?
- What is the clinical
reasoning for the selection of the particular sling?
Please click here to read the full study.
