Splinting, Orthotics, and Prosthetics Flashcards
Oval 8
Used to manage: mallet finger, swan neck and boutonniere deformities, trigger finger and trigger thumb, lateral deviation, arthritis, fractures and hypermobility
Spring loaded extension splint (LMB)
FO
Ideal for finger flexion tightness and boutonniere deformities
It produces extension of the joints of the fingers and/or thumb.
Dressing tree
A dressing tree is a term that indicates a system of hooks and pegs that can help people with an upper limb difference put on and take off, or don and doff, their prostheses without the help of others.
dressing trees can also help with clothes
Orthotic
A device applied to restore function or prevent deformity often by protecting the limb
Prosthetic
Usually indicates a replacement of a body part
Artificial limb, hip/knee replacement
Rules regarding orthotics and prosthetics
- If you don’t know what you are doing stay away or get help.
- No two patients have the same needs or problem (even if the diagnosis is the same).
Wolfe’s Law
Soft tissue responds to the forces placed upon it
Custom vs. Prefabbed orthotic
Once you touch the client you are responsible!
Custom: more expensive, used if wearing for a long period of time
Prefabbed: prefabricated, over the counter, only worn for a couple weeks
Precut becomes custom
Factors that can result in differences between patients and orthotics
Pathology and anatomy
Other disorders ect
Physiological function prior to injury
Psychosocial issues
Goals for that client
Amputation levels
Interscapulothoracic amputation
All of part of scapula is amputated along with the arm; can include clavicle
Four types of UE prosthetics
Cosmetic
Body Powered
Myoelectric
Hybrid
Cosmetic prosthetic
Use the term passive functional for insurance to cover it.
These prostheses are lightweight and while they do not have active movement, they may improve a person’s function by providing a surface for stabilizing or carrying objects.
Body powered UE prosthetics
$15,000
Cable driven
Internal or external
Driven by patient’s residual movement
- must have sufficient musculature and ROM
Advantages:
- pretty low tech
- gives good proprioceptive feedback.
- can get dirty or wet
Disadvantages:
- decreased grip compared to myoelectrics
- force is exerted on risidual limb
- can be difficult to control for high levels of amputation.
- restrictive harness
Myoelectric prosthetics
External powered
$80,000.00 and up
Triggered by a muscle contraction or pressure that activates a switch
Switch can be external or internal
All you need is one point
Often helpful to consult an OT or PT before the amputation occurs
Don’t like to get dirty or wet
Have to be charged
Hybrid prosthetic
Has both a body powered and myoelectric component
How to apply prosthetic
Vacuum (negative pressure)
Harness: figure 8 or figure 9 are the most common
Socket
Use of stump socks
- for molding (wrapping)
- for volume difference
- for protection
- to absorb perspiration
Shoulder units
Usually manually or friction operated
Elbow prosthetic
Myoelectric
Friction
Locking
Manual or cable operated
Wrist prosthetic
Hinges
Ball and socket
Fricking, locking, myoelectric
Terminal device
VO - voluntary opening
- Opens with effort and closes with relaxation
VC - voluntary closing
- Closes with effort and opens with relaxation
Depends on which muscle contractions are stronger
Hooks, hands or other
Goal is a three-point pinch
Role of OT/PT in orthotics
Correct fit and type
- Pre surgery consult
Educate the client
- Terminology
- Expectations
Prep the stump
- Desensitization starting day 1 after surgery
- Molding
Application
- Don and doff
Functional use
Prefabbed orthotics pros and cons
PROS
- Cheaper
- Less time and effort
- Immediate feedback
- Lots to choose from
- The “sports” look
- Still requires skill and knowledge
CONS
- Fit is compromised
- Little control over position
- Expensive to stock a bunch
- Fit the “average”
Custom orthotic pros
Fit the client
- Doesn’t immobilize all
Requires skill
Better compliance
More expensive
FO
Finger orthotic
HFO
finger hand orthotic
HO
hand orthotic
WHO
wrist hand orthotic
WHFO
wrist hand finger orthotic
EWHFO
elbow wrist hand finger orthotic
EO
elbow orthotic
SEWHFO
shoulder elbow wrist hand finger orthotic
Resting hand orthotic
WHFO
Resting pan
Antideformity
Antispasticity
Cock-up orthotic
Dorsal or volar based
Wrist immobilizer
WHO
Thumb spica
WHFO
CMC splint
HO
Static orthotic
Doesn’t move
Protect, rest, position
Static articulated orthotic
They can be hinged and locked (don joy)
- If they hold the joint still, they are hinged static
Static progressive orthotic
This type applies force to the stiff joint or tissue, holding it at end-range position to improve passive motion.
May be articulated or not
Cannot be used on clients with abnormal tone
Adjustments can be made based on client’s pace and tolerance
Dynamic orthotic
Encourage or promote joint movement
Often use rubber bands or other elastic components
Don joy allows, but limits movement (0-90º instead of 0-140º)
How to prevent torque deformity?
Torque deformity occurs when fingers start to twist or cross over.
The lower the profile, the lower the chance of getting torque deformity.
There should be a 90º angle from the point of pull to joint it is closes to.
Purpose of orthotics
Protect/prevent deformity
- supports an unstable joint
* arthritis
* post or pre surgery
* fracture management
* prevent contractures?
* CP
Improve ROM
- slow, continuous stretch
- block a joint
Improve function
- act as prosthetic
* nerve injury
* amputation
* CP
A few musts when applying an orthotic
Understand the anatomy of the hand
- the orthotic must fit and support the arches
- failure to do so will result in flat hand
Understand the creases and their role in free movement
Dual obliquity
- the variance between the length and height of the metacarpals, with the radial side longer and higher than the ulnar side
Apply minimal stretch
Be comfortable and wearable
Must cover only the joints necessary
Must be secure
Must be easy to apply and take off
Must be free of pressure points
What you need to start making orthotics
Thermoplastics
- 100s of types
- low melt: 100-140º
- high melt: 200º+
Splinting scissors
Heat source
- water
- guns
Straps
- velcro
- buckles, d-rings (transmit greater force)
Other stuf
- outriggers
- hooks, rubber bands, tubes
Properties of orthotic materials
Conformability - getting into the cracks and crevices
Weight or thickness
Flexibility - ability to take repeated stress
Rigidity - does it bend? how resistant is it to stress?
Durability - ability to tolerate wear and tear, how long will it last?
Solid or perforated
Color
Heat to cool time
Heat temperature
Memory
Elasticity
Drapability
Bonding
Edges
Resting hand/pan position
Wrist 10-20º extension
Slight flexion of digits
Orthotic functional position
Wrist 20-35º extended
Arches apparent
MPs slightly flexed
IPs 45-60º flexion
Thumb abducted and opposed
Intrinsic plus (antideformity) position
Wrist 10-20º extension
MPs 90º flexion
IPs 0º
Trough
Part of the forearm, dorsal or volar
2/3 rule
Hypothenar bar
area over small finger, dorsal or volar
MP bar
sits at or below the MP joint, dorsal or volar
Thumb hole/trough
Thumb area
C-bar
found on resting hand or thumb splints, sometimes stands alone
Pan
place the hand sits
Thumb post
Keep in mind the part you want blocked
Opponens bar
Area over thumb
Outrigger
Anything that comes off the splint
Orthotic straps
Hold the orthotic on
- usually velcro and foam
- can use D-rings, rivets, slits in splint for patients that need more than Velcro
Applying the straps
- usually has 3 points of pressure
* two in one direction and one in the other
- don’t block joints or pressure points
Round the edges
Cock up splint
WHO
Prefabbed if it’s for a short time use
Custom is always better
Used with
- carpal tunnel
- wrist sprain
- carpal fx
- tendonitis
- ganglion cyst removal
- after an arthroplasty
- radial nerve palsy
- protect wounds
Support the wrist, cerebral palsy, stroke
Base of many dynamic splints
Ulnar or radial gutter
WHO or WHFO
Looks like a cock up except it’s only hits one side of the forearm and hand
Same basic use as cock up
- especially carpal or metacarpal fx or thenar fx
Hand immobilizers
Resting hand, resting pan, intrinsic plus, or antideformity
WHFO
Protection for wounds, tendons, arthritic, flaccid hands
Typical for burns
Crush or major trauma
- often applied in operating room
Thumb spica or thumb immobilizers
WHFO
HFO
Used for
- DeQuervain’s
- athrtitis
- post CMC arthroplasty
- preventative for CMC arthritis
- scaphoid or thenar fx
- Gamekeeper’s thumb
- UCL tears
Elbow and forearm orthotics
Forearm - usually dynamic to increase supination or pronation
Elbow - usually to protect a fx or epicondylitis or block or increase movement
- can be static, dynamic, or static articulated
Elbow orthotics
Immobilizers following
- elbow fx
- arthroplasty
- instability
- biceps or triceps repair
- cubital tunnel
- burns
Static, dynamic, or hinged
Kleinert, Duran, or Chow orthotics
90º rule
Used for flexor and extensor tendon repairs
Takes the place of the affected tendon during the healing process
Functional orthotics
Tenodesis orthotic - used with C5-8 spinal cords to increase the strength of tenodesis action
Others for writing, creating a thumb or radial nerve
Serial casting
Typically a last resort unless part of protocol
Leave on 24 hours - 3 days later, remove and do again
Orthotic wear and care
Washing and cleaning orthotic straps
- remember melt temp
Send it home in writing
- what is it for
- wear time
- instructions in the use and to contact therapist
- do not attempt to adjust
Mallet finger
Rupture or interruption of the terminal extensor tendon
It will not get better.
What to do about mallet finger?
The only way it will heal without surgery is to leave it in place (extension) for 6-8 weeks and allow scar tissue to “glue” the tendon/rope back together. If you remove the splint and make ONE fist, prior to the 6-8 weeks, you will tear all the developing scar tissue and you have a cut tendon/ rope again! If you have to start over, it is less likely to heal!
Splint: the end joint (DIP) should be kept in an extension splint, it is best to tape it to the splint so that it will not move, the splint can be fabricated out of thermoplastics or you can use an aluminum splint, it can go on the top or bottom
What to do if mallet finger doesn’t go back perfectly straight after 6 weeks in an orthotic?
You must put the splint back on and keep it on for 4 more weeks then try it again
Dermatomes of the upper limb
