1. Foundations of Splinting

2. Definition of a Splint
Splint: An orthopedic device for immobilization, restraint, or support of any part of the body (Mosby 2002)
Orthosis: A force system designed to control, correct, compensate for a bone deformity, deforming forces, or forces absent from the body
Which one is the temporary?
Splint is temporary that is part of tx program.. Orthosis is permenant device to replace or substitute for a loss of muscle function
Both goal is not only to immobilize but mobilize, position, protect a joint or body part

3. History of Splinting
Started with carpenters and blacksmiths, used cloth, wood, leather and metal.
Prospered in World war II.
Development of LT thermoplastic materials – 1960s
American society for hand therapy (ASHT) association in 1977.
Exam – CHT

4. Splintmakers OTs PTs who specialize in hand rehabilitation
PTs often fabricate splints for the lower extremity
Certified orthotists
Experience in splinting

5. Frameworks for Splinting
OTPF, includes Performance areas (ADL, IADL, education, work, play leisure and social participation
Performance areas makes a demand on performance skills (motor, processing, communication skills… etc.)
Consider the influence on performance patterns (habits, roles and routines)
Never forget the context (cultural, physical, social, personal, spiritual, temporal and virtual dimensions)
Table 1-1

6. Frameworks for Splinting
Activity demand, includes object uses, space demands, social demands, sequencing, and timing.
Client factors, a persons body functions and body structure
Have a look at the example table page 5

7. Approaches for splinting
Rehabilitative: Tenodesis splint
Biomechanical: dynamic splint
Sensorimotor: antispasticity
Quiz 1-1
Rehabilitative focus on abilities rather than disabilities and facilitate returning person to maximum function using their capabilities
Biomechanical, uses biomechanics and kinetics of body
Sensorimotor, inhibit or facilitate normal motor responses in persons with central nervous system damages

8. Which approach are we using here?
Child with CP, the goal is to decrease the amount of tone present?
The goal is trying to regain full Range of Motion, what is the approach used?
The goal of this splint to assist with this grasp to be able to hold the walker?
Sensori motor
Biomechanical
Rehabilitative

9. Splint Design
Previously splints were divided into static or dynamic splint
Static splint have no moving parts, it places the tissue in a stress- free position to enhance healing and minimize friction
Dynamic splints have one or more moving parts, they include elastics, wires, springs…etc.

10. Splint Design The therapeutic interventions of splinting includes:
Static
Serial static
Dynamic
Dropout splint

11. Static splints
Maintain a position to hold anatomical structures at the end of available ROM, thus exerting a mobilizing affect on the joint

12. Serial static splinting
Remodeling of a static splint
Hold the joint at a tolerable degree of ROM, thus promoting tissue remodeling

13. Dynamic/ Elastic tension/ mobilization splints
They have self adjusting or elastic components (wires, rubber band, springs)

14. Dropout splint
Allows motion in one direction while blocking motion in another

15. Splint Design Many possibilities exist for splint formation
You need to be creative and have high skills of clinical reasoning to determine what is the best splint/ fabrication implications are.

16. Splint categorization
There are 6 splint classification divisions:
Identification of articular or nonarticular
Location
Direction
Purpose
Type
Total number of joints

17. Expanded splint classification system
Articular
Nonarticular
Location
Location
Direction
Mobilization
Restriction
Torque transmission
Immobilization
Type
Type
Type
Type

18. Identification of articular or nonarticular
Articular splints use three point pressure systems
It affects a joint or joints by immobilizing, mobilizing, restricting, or transmitting torque
Most splints are articular so you do NOT mention it in the name of the splint
Nonarticular splints use two points pressure force to stabilize or immobilize a body segment
The term nonarticular should ALWAYS be included in the name of splint (used in long bones of the body i.e. humerus)

19. Location
Splints are classified according to their primary anatomical part
So, in articular splints you will mention the joint name, like elbow, thumb, MP…etc.
Whilst in nonarticular splints you will mention the name of the long bone, like ulna, radius…etc.

20. Direction It is only applicable for articular splints only
It refers to the primary kinematic function of a splint
Examples like flexion, extension, and opposition are used to classify the direction of these splints
You would name a splint that is designed to flex the PIP joints of index, middle, wing and small fingers would be: index-small finger PIP flexion splint

21. Purpose There are four purposes of splints:
Mobilization: move or mobilize primary or secondary joints
Immobilization: immobilize primary or secondary joints
Restriction: limit a specific aspect of joint range of motion for primary joints
Torque transmission: a. create motion of primary joints situated beyond the boundaries of the splint itself
b. harness secondary driver joints to create motion of primary joints that maybe situated longitudinally or transversely to the driver joint
The purpose of the splint indicates how the splint works.
Example: Elbow immobilization splint

22. Type
The type of the splint specifies the secondary joints included in the splint.
Secondary joints are often incorporated in the splint design to affect joints that are proximal, distal, adjacent to the primary joint.
There are 10 joints in the upper extremity (shoulder, elbow, forearm, wrist, Finger MPs, finger PIPs, finger DIPs, thumb CMC, thumb MP, thumb IP)
We only count the joint LEVEL (not number)
Example, wrist + 3 PIP’s  2 level splint, so the name would be: index- small finger MP flexion mobilization splint type 2.
If no secondary joint are included, the level type would be type 0

23. Total number of Joints It follows the type indication
Example, An elbow splint that includes the wrist and MPs would be called: “elbow flexion immobilization splint type 3 (4)

24. Question?