1. Orthosis and Splinting OT 634

2. FOR for splinting  Biomechanical-  Uses principles of kinetics and forces acting on the body  Sensory motor FOR-  Used to inhibit or facilitate normal motor responses  Rehabilitation  Facilitates maximal function

3. Defining terms  Orthosis-  Any medical device applied to or around a body segment to address physical impairment or disability  Brace and support are terms used for an orthosis  a force system designed to control, correct, or compensate for a bone deformity, deforming forces, or forces absent from the body  Refers to a permanent device to replace or substitute for loss of muscle function

4. Splint  Device for immobilization, restraint, or support of any part of the body.  Usually thought of as more temporary than and orthosis  ASHT splint classification  Static splint  Serial Static splinting  Static Progressive splints  Dynamic Splints

5. Health professionals who deal with splinting and orthotics  OT’s/ COTA’s  CHT’s (can be PT or OT)  CO/ CPO  Dentists  Less common- nurses

6. Orthotic selection  What is the clinical or fxl problem?  What are the indications for and goals of splint use?  How will orthosis affect the problem and the client’s function?  Benefits of splint/ orthosis?  Limitations?  Custom made vs. pre-fab vs. No device

7. Splint related factors to consider:  Type  Design  Purpose  Fit  Comfort  Cosmetic appearance  Weight  Cost to purchase vs. fabricate  Ease of care  Durability  Ease of donning and doffing  Effect on unsplinted joints  Effect on function

8. Patient related factors  Clinical status  Functional status  Attitude  Lifestyle  Preference  Occupational roles  Living envio  Working envio  Social support  Issues related to safety and precautions  Ability to understand and follow through  Insurance and financial issues

9. Purpose of orthosis  Support a painful joint- slings, troughs, laptray and splints (p 319-323)  Immobilize for healing –dorsal block, buddy strap, figure 8, sh immobilizer  Protect tissues, gun slinger, airplane spl,  Provide stability and Restrict unwanted motion- resting pan splint, dorsal block  Restore mobility-drop out cast,flexion glove, dynamic ext splint  Substitute for weak or absent muscles- MAS, Deltoid aide, flexion assist spring, tenodesis splint, WDWHO, ratchet brace  Prevent contractures or Modify tone- air splint, ball splint, neoprene thumb loop, wt. Bearing splint,

10. Safety precautions for orthosis  Impaired skin integrity  Pain  Swelling  Stiffness  Sensory disturbances  Increased stress on unsplinted joints  Functional limitations

11. Construction of Hand Splints  Purposes:  Protection  Positioning for function  Immobilization for healing  Restriction of undesired motion  Correction or prevention of deformity  Substitution of absent or weak muscles

12. Anatomical considerations  Landmarks  Distal IP creases  DPC  Proximal palmar crease  Thenar crease  Wrist crease  Styloids, MP joints, IP joints, CMC, IP of Th

13. Anatomy (continued)  Arches of the hand  Longitudinal  Distal transverse  Proximal transverse  Fingers flex toward scaphoid  Functional position of hand  Position of safe immobilization- intrinsic plus position

14. Influence of splinting on tissue  Inflammatory phase- use splint to immobilize and protect  Fibroplastic phase: use splints to mobilze healing tissues while protecting  Maturation phase: low load force may be applied gradually increasing the stress tolerated

15. Tissue Remodeling  Ideal tissue remodeling occurs with gentle elongation of tissues (dynamic and serial splinting/casting)  Total end range time suggests that the amount of increase in PROM of a stiff jt is proportional to the time joint is held at end range (serial static splinting/casting)  Stress relaxation or static progressive stretch therapy

16. Mechanical principles applied to splint design  Increase the area of force application to disperse pressure  Increase the mechanical advantage to reduce pressure and increase comfort  Ensure three points of pressure  Add strength through contouring  Perpendicular traction for dynamic splinting  Acceptable pressure for dynamic splinting  High vs. low profile outriggers

17. Other considerations for splinting  Compliance  Offer options  Educate about benefits  Provide easy application and removal  Lightweight material  Immobilize only joints being treated  Cosmetically pleasing  Collaborate w/pt. On wearing schedule  Education

18. Construction of a hand splint  Design splint  Select material  Make pattern  Cut splinting material  Heat splinting material  Form splint  Finish edges  Apply straps, padding and attachments  Evaluate the splint for fit and comfort

19. Splinting Ch 1 in Coppard (Splint book)

20. Purpose of splints  Static  Rest  Prevention of further deformity  Prevention of soft tissue contracture  Substitution for lost motor function  Dynamic  Substitution for lost motor function  Correction of a deformity  Control of motion  Aid in alignment and wound healing

21. Types of Splints  Static splint  Drop-out  Articulated splints  Self adjusting or elastic components  Static progressive-  Hinges, velcro, turnbuckles  Serial static or casting

22. Materials and their properties  Low temperature thermoplastic  High temperature thermoplastics  Metal braces and parts  Soft splints  Properties of materials  Memory  Drapability  Elasticity  Bonding  Self-finishing edges  Time to heat

23. Performance characteristics of materials for splinting  Conformability  Flexibility  Durability  Rigidity  Perforations  Finish, colors, and thickness

24. Pattern Making  Tracing the hand  Marking landmarks  Cutting pattern  Fitting pattern on client  Forearm splint should go 2/3rds up forearm and trough should be ½ around the forearm. Should not restrict DPC if splint goes into hand, but doesn’t restrict fingers  Adjusting pattern  Refitting  Tracing pattern onto material

25. Cutting and molding a splint  Cutting material  Soften material  Mold material on client  Padding if needed prior to molding or after  Adjusting  Reheating vs. spot heating  Strapping  No tourniquet effect  Wider distributes pressure better

26. Documentation about splinting  Document why client needs splint  Position that client was splinted in  Instructions you gave client  Follow up needed