Assistive Technology Splinting

Created by binnmj8 

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65 terms

static splint-

immobilizes a joint

static splint used to? 4 things:

rest, protect, reduce pain, prevent contracture

serial static splint

a slow progressive increase in ROM, requires remolding

static progressive splint

includes a static mechanism that adjusts amt or angle of traction (built in adjustments, does not need remodeled)

purpose of splints

support, stabilize, prevent contractures, mobilize, increase independence, restrict ROM (aid in healing)

types of splints

restrictive- restrict ROM
immobilizing- prevent ROM
mobilizing-to increase ROM

Properties of splint materials

resistance to stretch
conformability or drape
memory
rigidity vs. flexibility
self-adherence
self-sealing edges
moisture permeability
color

categories of splint materials

plastic-high conformability and rigidity/ low resistance to stretch
rubber-high resistance to stretch/low conformability
plastic and rubber like- highly versatile
elastic-conform by stretch

Purpose of three arches of the hand

balance stability and mobility in the hand (longitudinal arch, distal transverse arch, proximal transverse arch)
L and D are flexible, P is rigid
*arches maintained by activity in the hand-s intrinsic muscles

Coordinated thumb, wrist, and finger movements enable the following grasp and prehensile patterns

tip to tip
palmar
lateral pinch
cylindrical
spherical
hook
intrinsic plus
interossei are active during grasp, power, and pinch grasps
Intrinsic plus- interossei and lumbricals are active
intrinsic minus-loss of normal arch, wasting of intrinsic musculature

Functional hand position: what degree?
wrist extension ____
ulnar deviation ____
digits 2-5 _____
MP flexion ___
PIP flexion _____
DIP flexion ____
thumb first CMC _____
partially abducted and opposed ___
MP flexion ____
IP flexion ___

wrist extension 20
ulnar deviation 10
digits 2-5
MP flexion 45
PIP flexion 30-45
DIP flexion 10-20
thumb first CMC
partially abducted and opposed
MP flexion 10
IP flexion 5

trough like splints should be ____ length of forearm and ____ circumference of arm

⅔ length of forearm and ½ circumference of arm

Thumb spica splint-

immobilizes the thumb while allowing other digits freedom to move along; thumb spica also immobilizes the wrist.

Styles of thumb spica:

volar, dorsal, radial gutter, hand based (short opponens)

Thumb spica: Volar

Immobilizes wrist, 1st CMC joint, depending on the height of thumb post, may stabilize 1st MP joint and/or 1st IP joint Volar surface of forearm is covered

Thumb spica: dorsal

Immobilizes Stabilizes wrist, 1st CMC joint, depending on the height of thumb post, may stabilize 1st MP joint and/or 1st IP joint Dorsal surface of forearm is covered

Thumb spica: radial gutter

Immobilizes Stabilizes wrist, 1st CMC joint, depending on the height of thumb post, may stabilize 1st MP joint and/or 1st IP joint Radial surface of forearm is covered

Thumb spica: hand based

Immobilizes 1st CMC joint, 1st MP joint, depending on length of thumb post, may stabilize 1st IP joint

Precautions for splinting

check for pressure over ulnar styloid, radial styloid
check for pressure over 1st MP joint, 1st web space is vulnerable to pressure and skin breakdown
-check for pressure along all edges
-make sure splint is not too constrictive
-be aware that material with memory will shrink during cooling
-make thumb opening large enough

Mobilization splints/ dynamic splints

-Have movable parts
-Designed to apply force across joints
-Forces use constant or adjustable tension (or both) to achieve goals

Goals of dynamic splinting

-Substitute for loss of muscle function, assist weak muscles
-Correct a deformity caused by muscle-tendon tightness or joint contracture
-Correction of a joint deformity
-Joint that has limited ROM may be the result of prolonged immobilization
-trauma
-significant scars from burns
-maintain AROM or PROM
-support pathological bones/joints
-muscle balance for paralyzed muscles or divided tendons/muscles
-provide rest to treat infection, promote healing

If a large discrepancy exist between Active and Passive ROM the goal should focus on

AROM and strengthening rather than splinting.

General goal of mobilization:

Increase ROM by 10 degrees a week; if PROM does not improve after 2 weeks you should re-evaluate the splint and tx goals

Provision of controlled movement

After arthroplasty or flexor tendon repair, especially with arthritis secondary to altered biomechanics for controlled mvt and alignment

Reasons for controlled movement

Moving the tendon forces the nutrient-rich synovial fluid into tendon to aid in healing
-By allowing 3-5 mm of tendon excursion therapist reduces adhesion formation between tendons and structures
-Tendons that are mobilized early display increased tensile strength compared with immobile tendons

Goals of dynamic splinting: Aid in fracture alignment and wound healing

Use of static tension while allowing joint mvt and via ligamentotaxis assist in alignment

The opportunity to affect collagen reformation is greatest during the _______ stage of wound healing but continue to a _______ degree while scar matures

proliferative, lesser,

Mechanics of dynamic splinting:

Force, translational force, stress, shear stress, friction, torque

Mechanics of dynamic splinting: Force

action or influence that either arrests, produces or changes the direction of the motion

Mechanics of dynamic splinting: Translational Force

a force that is directed towards joint compression or jt distraction

Mechanics of dynamic splinting: Stress

resistance to any force that strains or deforms tissue

Mechanics of dynamic splinting: Shear stress

when a force is applied to tissues at an angle or in opposing direction

Mechanics of dynamic splinting: friction

when one surface impedes or prevents gliding of a surface on another

Mechanics of dynamic splinting: torque

a measure of force that results in rotation around an axis

dynamic: Should never apply force to an injured joint until________and ______are under control

inflammation and pain

dynamic-Creep-

soft tissue structures respond to prolonged stress by changing or re-forming , involves adaptation of soft tissues as a result of application of prolonged forces

dynamic: With arthritis (jt instability) a force is applied too far from the jt will result in ______rather than _______

tilt, gliding

dynamic: Mechanical advantage involves consideration of forces applied by ______ _______ and _______ _______ __ ______.
___ refers to applied force and ___ refers to resistance force. Fm = (Fa=Fr)
Goal of splinting is to maintain Fm between 2/1 to 5/1

splint base and dynamic portion of splint
Fa, Fr
2/1 to 5/1

dynamic: When applying forces to increase ROM, must keep line of pull @ __ angle to the axis of the joint

90

dynamic: Distribute pressure of sling over a ______ ______ (acceptable pressure is ___g/cm 2)

wide area
50

dynamic: Should provide a _______ _______ not pain, always ______and _____ _______ as needed

gentle stretch, monitor, and make changes

dynamic: If stress to the tissue is applied over time and then relaxed, what will happen?

the tissue will no longer return to it's original shape, but will adapt to the new shape.

dynamic: Elastic limit of tissue: Stretching beyond it's elastic limit does not lead to permanent lengthening, but does what?

unwanted tearing and possibly further contractures.

dynamic: "True tissue growth occurs when...

"living cells will sense strain and collagen laid down again with modified bonding patterns with no creep and no inflammation."

Features of a mobilization Splint

Use of an outrigger- the projection from the splint that the mobilization force is attached to
application of forces

dynamic: outrigger: The material depends on ______ and ________of desired force

amount, position

dynamic: what happens if the outrigger is not secure?

will change the direction of mobilizing force and reduce the effectiveness of splint

Dynamic: outrigger: two types

high profile or low profile

Finger loops- use a _______material to prevent maceration

pliable

Springs are best for __________ ___________

consistent tension

_______ _______ are readily available

rubber bands

Use of velcro tabs- force is ________but is easily adjustable

static

dynamic traction

mobilization of a jt through the use of a force attached to an outrigger or through the use of a spring coil

Static Traction-

apply traction to immobilize or restrict motion

Serial Static Traction-

repeated adjustments in the splint that position a jt at its end ROM

Static Progress Traction

requires a built-in mechanism for adjusting the traction (turnbuckles, dynasplint)

Determining whether to apply static versus dynamic tension is dependent on?

end feel and stage of tissue healing.

Soft or springy end feel indicates

immature scar tissue

Hard end feel -

more scar or contracture- will respond to static tension only.

_______ tension will increase PROM faster than ______tension for any joint

static, dynamic

Tenodesis splint

Creates a functional grasp
Facilitates joint movement
Makes use of passive tension properties of muscles
Optimizes passive tension in muscles that cross multiple joints (wrist, MP, and IP joints)
Positions CMC joint so that pad of thumb comes in contact with lateral aspect of index finger facilitates lateral prehension

Tenodesis splint positioning for molding splint:

During molding, position thumb with wrist in extension, ensuring firm lateral pinch Proximal part of dorsal aspect of the splint must allow full wrist extension Space in palmar aspect of splint must be big enough to slide on and off with ease yet not so large that splint does not provide support.

Using tenodesis for functional activity: precautions

Risk of skin breakdown and pressure sores increase due to decreased sensation Make alterations if red areas on skin persist 20 minutes after removal of splint Make edges smooth through rolling and/or rounded edges Web space between thumb and index finger is a vulnerable area Manipulate resting length of muscles with care Avoid over stretching flexor digitorum profundus, flexor digitorum superficialis, and flexor pollicis longus Allow finger and thumb extension only with wrist flexion

MacKinnon Splint

-Semi Dynamic wrist splint that facilitates wrist ext while inhibiting finger flexor tone
-Provides touch to metacarpal heads while providing stretch to the intrinsic
-Also aids in thumb opposition

6 splint classification divisions

-identification of articular/nonarticular
- location
- direction
-purpose
-type
-total number of joints

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