Is a restraint (restural) glove an effective treatment option for a patient with Parkinson's disease?

Restural (Restraint) Gloves Are Not Recommended for Parkinson's Disease

Restraint gloves should not be used for Parkinson's disease patients, as they contradict evidence-based rehabilitation principles that emphasize promoting normal movement patterns, preventing learned non-use, and avoiding interventions that increase symptom focus or restrict functional limb use. 1

Why Restraint Gloves Are Contraindicated

Evidence Against Restrictive Devices

The occupational therapy consensus guidelines for functional neurological disorders (which share rehabilitation principles with Parkinson's disease) explicitly warn against restrictive interventions that:

• Increase attention and focus to the affected area, potentially exacerbating symptoms 1
• Promote compensatory movement strategies rather than normal movement patterns 1
• Lead to muscle deconditioning through immobilization 1
• Cause learned non-use of the affected limb 1
• Increase pain and potentially trigger complex regional pain syndrome 1

Recommended Approach Instead

For Parkinson's disease motor symptoms (tremor, rigidity, dystonia), the evidence supports:

• Engaging patients in tasks that promote normal movement, good alignment, and even weight-bearing 1
• Using the affected hand to stabilize objects during functional activities to avoid learned non-use 1
• Encouraging optimal postural alignment at rest and within function using a 24-hour management approach 1
• Grading activities to increase the time the affected limb is used with normal movement techniques 1

Evidence-Based Treatment Hierarchy for Parkinson's Motor Symptoms

First-Line: Pharmacotherapy

• Levodopa/carbidopa remains the gold standard and most effective treatment for motor symptoms 2, 3
• Administer at least 30 minutes before meals to optimize absorption 4, 5

Second-Line: Rehabilitative Therapy

• Exercise and neurorehabilitation are increasingly recognized as important tools to combat motor symptoms 3
• Physical, occupational, and speech therapies complement pharmacologic treatments 2
• Multiple randomized controlled trials support exercise and physiotherapy interventions 6

Advanced Treatment: Deep Brain Stimulation

• Both STN and GPi DBS are equally effective for treating motor symptoms when medication becomes insufficient 1, 4
• DBS is the most effective treatment for motor symptoms in appropriate patients 3

Common Pitfalls to Avoid

• Never use restrictive devices like restraint gloves that prevent normal limb use and functional engagement 1
• Avoid serial casting for fixed functional dystonia, as it has been associated with worsening symptoms 1
• Do not issue splints without careful consideration, and only after trying strategies that encourage normal movement patterns first 1
• If any restrictive device is considered, patients must be monitored regularly and empowered to discontinue use if adverse effects occur 1