The outcome measures were taken by one of four blinded and trained assessors who assessed participants of both groups. The post-intervention and follow-up assessments were done more than 24 hours but within 3 days after the splint (and electrical stimulator) had been removed. Passive wrist extension was measured with the application of two stretch torques (2 and 3 Nm) using a standardised procedure

(Harvey et al 1994). Measurements with a torque of 1 Nm were considered initially but abandonded because of problems attaining meaningful results. This procedure has high Autophagy Compound Library test-retest reliability (Intra Class Correlation 0.85). The arm and hand were positioned on the measuring device with the participant lying in supine Selleckchem CP-868596 and the shoulder in 30–45 degrees of abduction and the elbow fully extended (see Figure 1). Two participants had the measurements taken in supine with the elbows slightly flexed and three

participants were tested in sitting with elbow in 90 degrees flexion because of shoulder or elbow pain. Once the position was determined at the baseline assessment, the same position was used for all subsequent assessments for each participant (post-intervention and follow-up). A pre-stretch was applied to the wrist and finger flexor muscles for 30 seconds. Stretch torques of 1 Nm, 2 Nm, and then 3 Nm were then applied using a spring balance which was kept perpendicular to the hand. Wrist extension (in degrees) at torques of 2 Nm and 3 Nm was measured using a protractor attached to the measuring device. Strength of the wrist and finger extensor muscles was determined with a dynamometer. This method has a high inter-rater reliability with an Intra Class Correlation Coefficient

range of 0.84 to 0.94 (Bohannon 1987). The dynamometer was secured on a purpose-built platform. Participants sat with the arm secured on the platform and were instructed to push their hands against the heptaminol dynamometer as hard as possible for 3 seconds. They were given 5 attempts with at least 10 seconds rest between each attempt. The best of 5 measurements was used for analysis. The readings of the dynamometer (in kg) were converted to Newtons and then to torque values (in Nm) by multiplying the reading in Newtons by the distance between the wrist and the point of application of the dynamometer (ie, distal end of the second metacarpal). Spasticity of wrist flexor muscles was assessed using the Tardieu Scale (Tardieu et al 1954). The Tardieu Scale has a high percentage close agreement with laboratory measures of spasticity (Patrick and Ada 2006). Participants were instructed to relax during the test. The assessor moved the participant’s wrist as fast as possible. Reaction to passive stretch was rated on a 5-point scale. Motor control of the hand was assessed using the hand movement item of the Motor Assessment Scale (Carr et al 1985). The Motor Assessment Scale has a high test-retest reliability with a mean Intra Class Correlation Coefficient of 0.