1. Splinting Material, Processes, Tools and Techniques
Chapter 3

2. Is Splinting the answer?
Use the Clinical Reasoning approach…
Activity analysis approach…
Anatomy and biomechanics…

3. Purposes of splinting Improve position Prevent deformity/contracture
Correct deformity/ contracture
Provide rest to a joint b relieving stress
Maintain skeletal alignment
Improve function
Position extremity for improved function

4. Continued… Assist weak movement Substitute for absent movement
transfer movement from one joint to another
Assist muscle re-education and exercise
improve independence in activities of daily living

5. Splinting materials Low- temperature thermoplatic (LTT) material
Soften in water heated btw 135 F and 180F (57º - 82º C)
Therapist can put safely on patient’s skin while plastic is still moldable
HTT material warmed to >250 F, cannot touch skin

6. LTT often used to adapt devices for improving function
Example?

7.
Polycaprolactone (PCL) is a biodegradable polyester with a low melting point of around 60°C and a glass transition temperature of about −60 °C. The most common use of polycaprolactone is in the manufacture of speciality polyurethanes. Polycaprolactones impart good water, oil, solvent and chlorine resistance to the polyurethane produced.
This polymer is often used as an additive for resins to improve their processing characteristics and their end use properties (e.g., impact resistance). Being compatible with a range of other materials, PCL can be mixed with starch to lower its cost and increase biodegradability or it can be added as a polymeric plasticizer to PVC.
Polycaprolactone is also used for splinting, modeling, and as a feedstock for prototyping systems such as a RepRap, where it is used for Fused Filament Fabrication (similar to theStratasys' Fused Deposition Modeling or FDM technique).

8. PCL also has many applications in the hobbyist market (sold under various tradenames, such as "InstaMorph", "Friendly Plastic", "ShapeLock", "PolyMorph", "Plastimake", "Plaast" etc). It has physical properties of a very tough, nylon-like plastic that melts to a putty-like consistency at only 60 °C. PCL's specific heat and conductivity are low enough that it is not hard to handle at this temperature. This makes it ideal for small-scale modeling, part fabrication, repair of plastic objects, and rapid prototyping where heat resistance is not needed. Though molten PCL readily sticks to many other plastics, if the surface is cooled, the stickiness can be minimized while still leaving the mass pliable.

9. Material selection Patient population Diagnoses Therapist preference
Availability

10. Material selection Decisions on the best material are based on: Cost
Properties of thermoplastic material
Familiarity with splinting materials
Therapeutic goals

11. Handling characteristics Performance characteristics
Material properties When heated and softened
Performance characteristics
Material properties after the material hardens and cooled

12. Handling Characteristics of Splinting Materials
Low Temperature Thermoplastics
Warm water for consistent and overall coverage
Heat gun for spot heating or dry heat
Advantage: Can work with material directly on skin
Disadvantage: May melt in hot car or if left near hot surface

13. Memory
Ability of the material to return to former size, shape and thickness when re-heated (ranges from 100% to little or no memory)
100% memory (turn clear): return to the same thickness &size
Advantage: easier to "start over" novice therapists, serial splinting (spastic)
Disadvantages: Constant molding required during the cooling process. 
May "shrink" during cooling (Spot heating)
Constantly moulded throughout the cooling process

14. Drapability
Ability of material mold intimately over contours of extremity without manual assistance
Degree of ease with which the material conforms to the underlying shape
Advantages: conforms well
Disadvantages: Prone to fingerprints of therapist, Poor memory, Stretches and "grows", Requires cooperative patient,                          
Requires a light touch

15. Elasticity
Material’s resistance to stretch and tendency to return to it’s original shape after stretch
Advantages: Can tolerate a heavy touch
Good with uncooperative patient, high tone, when including multiple areas
Disadvantages: Difficult to mould to contours

16. Self Bonding (uncoated)
Ability to adhere (stick) to itself when heated
Coated material required bonding agent
Advantages: Can secure extra piece to the splint, such as when attaching a piece of hardware in dynamic splint
Disadvantages: Difficult to take apart if the material folds
What is scoring?

17. Self-finishing edges
Edge is smooth and clean when cut Decreases need to roll edges
Advantages: less jagged edges, less risk for pressure sores

18. Heating time
Working time
shrinkage

19. Performance Properties of Splints
Conformability
Fits intimately into contoured areas
More comfortable
they distribute pressure best
No migration of splint on extremity
High drapable

20. Performance Properties of Splints
Flexibility
Able to withstand stresses repeatedly
Bends easily
Example?
Circumferential splints

21. Performance Properties of Splints
Durability
Length of time a material will last before becoming brittle with age

22. Rigidity
Strong
Does not bend easily
Medium to large splints
To support the weight a larger joints
In small splint it is important if the splint
Is to stabilize a joint
Most LTT material cannot tolerate the repeated forces involved in WB such as in foot orthoses

23. Perforation
Moisture permeability
Air exchange
Mini
Maxi
Micro perforated
Reduce the weight of splint
Should not be stretched. Increase the holes
Decrease strength and pressure distribution
Cutting a perforated splint

24. Finish
Texture of the surface, smooth or grainy texture
Colour
Commonly white but tan
A variety of other colours are available in some products
Bright colors with children
Colored with unilateral neglect

25. Thickness
Common thickness is 1/8 inch
This will soften and hardens faster than thicker material
Thinner are used for children or for small splints and arthritis patients

26. Sticky-backed Velcro
Bonds best when heated (dry heat) Rounded corners prevent "catching
Padding
Bonds best when heated (dry heat) Changes fit of splint (smaller, tighter) Moisture and odor absorption requires replacement

27. Splint fabrication Process
Creating a Pattern
Choosing appropriate material
Choosing the type of traction
Choosing splint design for a given purpose
Fabrication

28. Step 1: Creating a Pattern
Necessary for success
Pattern should be made
Standard patterns
Tracing the outline of the hand (or body part)
Position error (flat and neutral)
Contra-lateral hand
Landmarks of hands
Draw splint pattern over the outline of the hand
Cut out the pattern

29. Step 2: Fitting the Pattern to the client
Fit the pattern on the extremity
Adjust the size and shape by adding or subtracting from the pattern, using scissors and paper tame, so that the pattern conforms to the area to be covered by the splint
Palpate through pattern material to find bony landmarks, borders, creases and skin folds, to provide cues to outline area
If a pattern is cut much larger than necessary the splint will be difficult to mold. The pattern is easier to mold if cut true to size    

30. Step 2: Fitting the Pattern to the client
Moistening the pattern paper
Make a new pattern - major changes
Form 3-1 hints for drawing and fitting a splint pattern

31. Step 3: Tracing, Heating and cutting
After making and fitting the pattern to the client, therapist place on material sheet
Trace it with a pencil, grease pencil
Ink may smear into the plastic
Ink maybe removed with clorine
Cut with knife, or scissors (pattern maybe cut later .. Cut sheet into two halves

32. Step 3: Tracing, Heating and cutting
Electric fry pan (Sause pan)
Temperature dial (160 F)
Water high (two thirds full) or (2 inches deep)
Take out of water
Put on mesh / flat cloth
Cut pattern with long blade strokes
Do not use the tip of the scissor

33. Step 3: Tracing, Heating and cutting
After cutting the pattern from the sheet
Position client
Reheat the pattern

34. Step 4: Position client Seat client comfortably for elbow and hand
Gravity assisted.. Dorsum of hand on towel roll, Forearm in supination
OR: Hand in vertical position
Stiff hand??
Pain medications (30-60 min)

35. Step 5: Molding the splint to client
Retrieve material from water
Wipe off any excess water
Check how hot is the material
Fragile skin?
Material sticking to hair?
Cold spray? Dip in cold water

36. Step 6: Making adjustments
Cut with scissor
Dip in hot water
Heat gun (off, cool, hot)
Warm unevenly
Don’t use for major changes
Hot-cold line
Attachments

37. Step 7: Strapping Velcro hook and loop With /without adhesive back
Variety of width and clors
Rounded corners of velcro?
Adhesive on scissors
Padded straps
Give extra to client
Avoid losing straps fig 3-6

38. Step 8: Padding To avoid pressure areas
Heat gun and push away from bony prominence. (The ulnar head)
Allow for padding space in the splint
Gel disks
Put putty over prominence before applying material
Replacement (open cell padding)

39. Step 9: Edge finishing If no self-finishing edges: Edges should be:
Smooth
Rolled
Flared out
If material cut hot.. Finishing of edges not needed
Use heat gun or heated water in fry pan
Smooth finger prints with water

40. Step 9: Edge finishing Finish Splint Edges
Try these techniques to find which works best for you.
Heat edges and trim with scissors
Heat edges and rub with a wet finger
Edges may be smoothed with an electric grinder or sander
Dip in hot water until edges clear. Flare edges outward.
Hardened edges may be trimmed with a deburring tool.

41. Splinting precautions
Alter splint if red areas on skin persist 20 minutes after removal of splint
Increasing surface area of splint decreases potential for pressure sores
Arm toughs should be 2/3 length of forearm
Troughs should be ½ the circumference of body part

42. Avoid pressure over bony prominences
A pressure point should be bubbled out or enlarged rather than cut or padded
Smooth, rolled or rounded edges decrease pressure sores
Address moisture due to perspiration, wound drainage to avoid skin breakdown or infection

43. Give careful consideration for the following:
The needs and expectations of the patient
Position
Areas to be supported
Distribution of support (total contact Vs. small areas of contact)
Areas to be exposed

44. Continued… Exposure of sufficient tactile surface for sensory input.
Points and directions of forces.
Movements which may be restricted by the splint
Ease of application and removal of splint.