Week 9: Splinting on UE

Question 1

Include one or more resilient components (elastics, rubber bands, or springs) that produce motion
Designed to increase passive motion, augment active motion by assisting joint through its range or substitute for lost motion
Includes static base on which movable components can be attached
Common use is to gain greater finger ROM by adding dynamic MP extension and or MP flexion components to splint

Answer 1

Dynamic splints

Question 2

Types of splints?

Answer 2

Dynamic splints
Static
Serial Static
Static Progressive

Question 3

Has no movable components and immobilizes joint or part
Fabricated to rest or protect, reduce pain, prevent muscle shortening or contracture
Example: resting pan splint that maintains hand in functional or resting position

Answer 3

Static

Question 4

Achieves slow, progressive increase in ROM by repeated remodeling of splint or cast
Has no movable or resilient components but is a stic splint whose design and material allow repeated re moldings
Each adjustment repositions part of end of available range to progressively gain passive motion
Example: cylindrical cast to reduce a PIP joint flexion contracture through frequent removal and recasting

Answer 4

Serial Static

Question 5

Include static mechanism that adjusts amount or angle of traction acting on a part (turnbuckle, cloth strap, nylon or buckle)
Distinguished from dynamic splint by its lack of resilient force
Distinguished from serial static splint bc has built-in adjustment mechanism, so part can be repositioned at end range without need to remold splint
Can be adjust by client as prescribed or tolerated

Answer 5

Static progressive splint

Question 6

Limit joint ROM byt don’t completely stop joint motion
Example: Oval-8 ring splints (page 771) blocks PIP joint hyperextension while allowing unlimited PIP joint flexion
Semiflexible splints available too that limit motion at extremes of range byt allow motion in middle of range

Answer 6

Restrictive splints

Question 7

May fit for protection to prevent injury, for rest to reduce inflammation or pain, or for positioning to facilitate proper healing after surgery
Example: resting pan splint positions wrist and digits to maintain soft tissue length and protect desensate hand against damage (use post CVA)

Answer 7

Immobilization splints

Question 8

Increases limited ROM or to restore or augment function, assist weak muscle or substitute for motion lost because of nerve injury or muscle dysfunction, increase ROM of contracted joints (like serve finger stiffness due to edema)
May attempt to balance pull of unopposed spastic muscles to prevent deformity or joint changes and to assist function, resistance against which a weak muscle can exercise to improve its strength or facilitate tending gliding after tendon surgery

Answer 8

Mobilization splints

Question 9

Design of splints?

Answer 9

single surface, circumferential, or three-point design

Question 10

____ is limited to acting on finger IP joints by providing loop of material that wraps around joints to restore final degrees of joint flexion.

Answer 10

loop

Question 11

____ used to cover only one surface (volar or dorsal surface of a limb, or the ulnar or radial half of hand or forearm). It requires properly placed straps to create 3-point pressure systems to secure splint and ensure distribution of pressure
Effective for supporting joints surrounded by weak or flaccid muscles like post CVA or PNI
Since little or no active motion is available, extra control given by circumferential splinting is not needed, and don/doff easier for single surface
Effective based for attaching outriggers in dynamic splinting and for post-op splints which fabrication of circumferential splint may damage repaired structures

Answer 11

single surface splinting

Question 12

____ for circumferential splinting
wrap around a part, covering all surfaces with equal amounts of pressure. It creates multiple three point pressure systems to secure splint for immobilization. Straps used solely to close splint or create an overlap.
Thinner materials can be used in molding
Effective for immobilizing painful joints or for protecting soft tissue
Gives comfy complete control, helpful when client wears during activity
Good to use for serial static splints used to reduce contractures and for stabilizing proximal joints when outriggers are applied to act on more distal joints

Answer 12

circumferential splinting

Question 13

What to look for if considering splinting

Answer 13

Compliance issues
Ability to don and doff a splint
Skin tolerance and hypersensitivity
Wearing schedule

Question 14

Resistance to stretch

Answer 14

Describes extent to which material resists pulling or stretching. Greater resistance, greater degree of control splint maker will have. Holds shape better and good for large splints and splints for people who are unable to cooperate in fabrication process

Less resistance to stretch, more likely material is thin during fabrication process. Advantage of stretch is greater in degree of comfortability attained with less effort on part of splint maker

Question 15

Conformability or drape

Answer 15

Conformability and resistance to stretch describe same characteristics which is if a material stretches easily, it will have better drape and conformability. Advantage of materials with high degree of conformability is that with light, controlled touch, they conform around part for precise fit

Disadvantage of high degree of drape (low resistance to stretch) is they tolerate only minimal handling, and care must be taken to prevent overstretching and fingerprints in material. High drape not recommended for large splints or uncooperative clients. But ideal for splitting post op clients when minimal pressure is desired, and for dynamic splint bases. Materials with low degree of drape must be handled continuously until fully cooled to achieve contoured fit; they don’t conform intimately around small parts of fingers

Question 16

Memory

Answer 16

Ability of material, when reheated, to return to its original flat shape

Advantage of high memory is splint can be remolded repeatedly without thinning and weakening material. High memory can be used to advantage with clients who require more aggressive handling to achieve desired position

Disadvantages are tendency to return to flat sheet state when an area is spot heated for adjustments and their needed for longer handling to ensure they maintain molded shape until fully molded

Question 17

Rigid v. Flex

Answer 17

In cold splint material, describe amount of resistance a material gives when force is applied to it

Highly rigid material is resistive to applied force and with enough force can break
Highly flexible bends easily and it is not apt to break under high stress, easier to don and doff, good for clients unable to tolerate more rigid material

Thicker thermoplastic and more plastic formula contains, more rigid material will be (thickest is ⅛ inch thinnest is 1/16 inch)

Question 18

Bonding

Answer 18

Ability of material to adhere to itself when warmed and pressed together
Uncoated materials have very strong bonding properties

Question 19

self sealing edges

Answer 19

Edges that round and seal themselves when heated material is cut, produces smooth edges that require no additional finishing.
Materials with little or no memory and high conformability produce smooth, sealed edges while with memory and high resistance to stretch resit sealing requires additional finishing

Question 20

soft splint material

Answer 20

Cotton duck, neoprene, knit elastics, plastic-impregnated materials used alone or in combo with metal/plastic to fabricate semi flexible splints which is used during sporting activities, assist clients with chronic pain, used for geriatric clients and those with arthritis who can’t tolerate rigid splints

Question 21

Splints need close conformability around part when they serve as base for dynamic splint, stabilize part of body, reduce contractures, remodel scar tissue, or immobilize to facilitate healing. These should be made from high degree of conformability
Splints for burns and other acute trauma do not require conforming a fit and can be made from low drape materials
For positioning of spastic body part, use materials that resist stretch and tolerate aggressive handling

Answer 21

Forearm-based and hand-based splints

Question 22

Need high resistance to stretch for making splints for elbow, shoulder, knee, ankle to provide control needed to deal with large pieces of material
Does not need to be highly conforming because they are molded over broad expanses of soft tissue
Care needed to provide relief for bony prominences or provide padding to distribute pressure

Answer 22

Large upper and lower extremity splints

Question 23

Need high degree of memory and material able to tolerate stretching without forming thin spots needed to design splint that wraps around part
Materials must be highly perforated, thin, and able to stretch evenly. After stretched, materials will cinch around body part while still allowing flexibility to easy don/doff. Materials like this and semiflexible materials best for fracture bracing and circumferential splits used for contracture reduction and for stabilizing joints, easy to don/doff and allow limited motion within available arc of motion

Answer 23

Circumferential splints

Question 24

Serial splints that require frequent remolding to accommodate increases in joint ROM should be made from material that has memory or highly resistant to stretch to avoid thinning. Should have moderate to high rigidity when molded

Answer 24

Serial splints

Question 25

Mechanism moves or is resilient and purpose is mobilization of joint through use of resilient force attached to outrigger/spring coil
Spring coil best suited to assist weak muscles or substitute paralyzed muscles (client with weak muscles likely to wear splint for long time and during ADLs). Spring coil is light and retains their force, rarely adjustable, ideal of long term use and less likely to interfere with hand function
Splints with outriggers good choice for splinting postop clients since they allow for adjustments to maintain correct positioning, accommodate changes in bandage thickness and edema. Client would use short time about 4-6 weeks. Client will not be returning to normal functional activities with affected hand during that time, so it is important splint able to be self donned because it is usual for client to remove it for periods of time or alternate with other splints
Splints with outriggers ideal for contracture reduction
Most effective when used during early stages of healing, when contracture feels soft and easy to reduce and clients will have pain and inflammation so rigid, static splint will be hard to tolerate

Answer 25

Dynamic trction

Question 26

Purpose for static traction splints is to apply traction to immobilize/restrict motion (resting, protecting, positioning)
When they restrict they are blocking motion, aligning joints, or limiting motion. When used to mobilize, they are used in a serial static or static progressive fashion to reduce contractures and remodel scars.

Answer 26

Static traction

Question 27

Fabricated by repeated adjustments that position a joint at its end ROM each time to achieve slow, progressive increases in ROM
Example: cylindrical cast made for gaining PIP extension must be remade after time (1-2 days) to reposition joint at end of ROM

Answer 27

Serial static traction

Question 28

Requires built in mechanism for adjusting traction. Choosing between turnbucke, velcro, or buckle depends on availability, OT experience, and client ability to manage mechanism. Best to choose simplest component that will achieve desired goal
Serial static splints useful for difficult clients who have high muscle tone or cognitively impaired and would have problems with adjustment mechanisms, and gives OT control needed for clients who are noncompliant or overly zealous and apply too much force. Disadvantages are splint requires more OT time since it must remodeled many times, and if client does not remove it for several days, some ROM may be lost
Advantage of static progressive splint are that oT has to make only one splint, and reliable clients with normal muscle tone may make more rapid progress. Disadvantage of static progressive is that it can’t be used on clients who have abnormal tone or who is unreliable

Answer 28

Static progressive traction

Question 29

Implications of application of force

Answer 29

All splints apply force and some degree stress on structures they contract
Pressure causes ischemia (localized anemia caused by obstruction of blood supply to tissues) and pressure is increased when splint contoured too sharply, doesn’t conform uniformly, or when they don’t cover broad enough area of soft tissue
Splints that move on hand because of insufficient strapping or contouring may apply pressure in areas that asp;lint was designed to relieve

Question 30

Choosing a splint design for a given purpose

Answer 30

Mobilizing splints to remodel scar tissue and reduce contractures

Immobilizing and restrictive splints for pain reduction

Immobilizing splints for positioning

Question 31

a. Scar tissue is one of major contributors to deformity and joint changes. Scar tissue must be remodeled. Heat can help tissue become more elastic.
b. Three-point splints can be used for flexion contractures
c. Loop splints for IP joint extension contractures
d. Outriggers for MCP extension contractures

Answer 31

Mobilizing splints to remodel scar tissue and reduce contractures

Question 32

a. Splints can reduce pain by providing rest and support
b. If injury caused by acute sprain, splint will probably be immobilizing until pain and
edema subside
c. If pain is chronic, then a semiflexible restrictive splint may be used
d. Also important is deciding need for full-time or intermittent wear. This depends upon
patient compliance and tolerance, integrity of tissue, material, ability to don/doff splint
e. Important to consider what structures need to be immobilized or supported and which
should be left free. With protective or pain reducing splints, must splint only involved
structures while leaving uninvolved structures free to move
f. If used for ADLs, may need semiflexible material.

Answer 32

Immobilizing and restrictive splints for pain reduction

Question 33

drange to maintain optimal mobility. Sometimes positioning splints are used to
position joints at end range to prevent contractures in the presence of severe tissue
damage (i.e. burns)
b. May need to be repositioned to account for edema and bandages, may need to be
volar or dorsal, may need to be easier to don/doff. Therapist must assess individual
needs

Answer 33

Immobilizing splints for positioning

Question 34

Steps to splinting…

Answer 34

Step 1: creating a pattern
Step 2: Choosing appropriate material 
Step 3: choosing type of traction
Step 4: Choosing a splint design for a given purpose
Step 5: Fabrication