The Givmohr Sling For Low Tone Upper Extremities During Upright Mobility

Background: Motor weakness or paresis/paralysis is often seen in people with Multiple Sclerosis (MS).  Usually this is progressively associated with increased tone or spasticity, however, occasionally low tone may be present.   A low tone/flaccid upper extremity (UE) is at risk for injury and interferes with the person’s ability to perform functional activities including gait. The GivMohr sling, specific for low tone UE’s, has been shown to reduce subluxation and increase gait velocity in subjects following stroke.  It is designed to position the UE appropriately while providing joint compression through the UE.  The sling holds the extremity in a functional position with retraction and depression of the scapula, the humerus in near neutral rotation, and the elbow in mild flexion.  This position leaves the involved UE free to swing and provide counterbalance weight shifting in the upright position. 

Objectives: To determine if the GivMohr sling demonstrates long term changes in gait in a subject with a flaccid UE  

Methods: A single subject, repeated measures design.  A 61 year old female s/p CVA with right sided hemiparesis, with a flaccid upper extremity.  Two months post (time A), and again at 6 months (time B),  she walked across the GAITRite mat, with and without the GivMohr sling in a randomly assigned order.  She walked at a self-selected speed with standby assist for safety.

 Results: Gait velocity: time A without sling =25.6, with sling =26.5; time B without sling =65.4, with sling= 69.0.  Step length involved side/uninvolved: time A without sling = 22.8/26.9, with sling = 25.2/36.5; time B without sling = 38.3/45.2, with sling = 39.5/44.3

Conclusions: Use of the GivMohr sling enhanced the subjects gait at both evaluation times.  Her gait improved between the two testing sessions, however, the enhanced variables of increased velocity and changed  step length between sides of her body when wearing the sling were still demonstrated at time B. 

 While low tone extremities are not the norm in people with MS, it is a possibility, perhaps due to a secondary complication.  Maintaining functional mobility in individuals with MS is crucial over time, even with a flaccid extremity. The GivMohr sling is a simple and inexpensive option that not only supports and protects the UE, but properly positions it during upright postures. The sling may be an appropriate treatment option for some people with MS.