SPLINTING FOR POSITION AND FUNCTION

SPLINTING FOR
POSITION AND
FUNCTION
Alyssa Dahlheimer, OTR/L, CHT
Objectives
• Determine when and why to splint in pediatric populations
• Which types of splints work well for various purposes
(different joints, day/night, prefabricated or custom)
Why splint?
• Keep muscles, tendons, ligaments, stretched and
extensible when unbalanced muscle tone is present
• Position a joint for increased function
• Protection
• In pediatrics, dealing with growing bones and if the
muscles do not elongate with the bone, a contracture will
result.
Splinting patients with unbalanced
muscle
tone
• Cerebral Palsy, Traumatic Brain Injury, Stroke,
Brachial Plexus injury, SCI
• Wrist hand orthosis
• Made out of a double layer of Ezeform
• Typically worn at night, leave hand free during the day
Splinting patients with unbalanced
muscle tone
• Y-strap (Patterson medical), comes in a variety of sizes.
Getting the right fit-WHO
• 2/3 length of the forearm
• Circumference-about ½
• Palmar arches
• Thumb position
• Wrist in about 20 degrees extension
• Smooth edges
• Strapping
WHO with elastomer
• Can add this to splint for added positioning/stretch, scar
management.
Prefabricated wrist hand orthosis
• Benik with volar pan
• RCAI
• Comfy
Gradually increasing the stretch
• FDS and FDP cross the wrist,
so the amount of stretch
at the fingers is dependent
on the position of the wrist.
Wrist splints: positioning for function (and
to prevent deformity)
• Lots of options!
Wrist splints: positioning for function (and
to prevent deformity)
• Benik wrist with metal stays
• Benik wrist with metal stay and neoprene thumb
Wrist splints: positioning for function (and
to prevent deformity)
• Thermoplastic wrist
with neoprene thumb
• Thermoplastic wrist
and thumb
Wrist splints: positioning for function (and
to prevent deformity)
Benik custom order
Custom-made wrist splints
• Radial bar/wrist cock-up
Pre-fabricated wrist splint options
• Exos splint
Pre-fabricated wrist splint options
• Zipper splint
Getting the right fit-wrist splints
• Allow MCP flexion, fit just proximal to the distal palmar
•
•
•
•
crease.
2/3 length of forearm
Ulnar styloid
If splint includes thumb abduction, usually want to leave
the thumb IP free.
If splint does not include thumb, make sure patient can
perform thumb opposition
Splints to position the thumb
McKie splints
Splints to position the thumb
• Benik thumb abduction splint (BD-88)
Splints to position the thumb
Custom thumb spica
Getting the right fit-thumb splints
• IP free
• Allow wrist flexion and extension
Elbow extension splints
• Custom made
Elbow extension splints
• Comfy splint
• RCAI
Getting the right fit-Elbow splints
• More surface area reduces pressure points (splint and
straps)
• Use leverage
• ½ circumference of the arm for custom
Ideas for compliance
• Add iron on decals to the neoprene splints
• Patient chooses strapping color
• Patient chooses color on custom order
• Talk about why the splint is important
• For younger patients, put the splint on when they are
already asleep.
Ideas for compliance
• rivets
Wearing Schedules
• Gradually increase wear time
• Check for red marks (30 minutes)
• If bilateral splints, can alternate wearing every other night
• Make sure family understands how to wash/dry them
Case Studies over an episode of care
• 4 year old girl with hemiplegic cerebral palsy (left side)
• Nice active shoulder and elbow motion
• Her wrist, fingers and thumb are in flexion most of the
time (thumb collapse)
• Can actively extend wrist to almost neutral, can extend
fingers about ½ range, little thumb active motion.
• Has come to OT on/off for a few years and tried several
splints (custom WHO, Benik wrist with neoprene thumb,
McKie thumb)
Case studies
• Before discharge she started to figure out synnergistic
movement patterns (wrist flexion to extend fingers, wrist
extension to flex fingers)
• Which splints she was using at discharge:
• RCAI wrist hand orthosis (she liked because of padding
and it worked because she has PROM that allows her to
wear it)
• Exos thumb spica splint (needed high stability and skin
reaction to neoprene), also did not want to block wrist
Case studies over an episode of care
• 10 month old boy with Arthrogryposis
• Bilateral position of elbow flexion, wrist extension, thumb
IP flexion, thumb adduction, MCP flexion.
• Started out with wrist hand orthosis, had to position his
thumbs in radial abduction rather than palmar due to
passive range of motion. Splints went as far to elbow as
possible to balance out wrist extension.
• Mckie newborn size thumb abduction splints for daytime.
• Came in 1x/month for splint modifications, increase wrist
flexion toward neutral.
Case studies over an episode of care
• Now his wrists are at neutral, continuing to wear at night
• Recently made elbow extension splints (family as been
doing PROM), can come to 90 degrees.
• Initial plan was to alternate right WHO/left elbow splint
with left WHO/right elbow splint every other night.
• Could not sleep with elbow splints on, moved to trying to
get a couple of hours of time in elbow splints during the
day.
• Transitioned from McKie to a thermoplastic Benik thumb
abduction splint because he was overpowering the Mckie.
Case studies over an episode of care
• 7 year old girl with a birth brachial plexus injury
• At birth, demonstrated limited movement in wrist and
finger extension, elbow flexion, shoulder flexion,
abduction, external rotation.
• She wore a WHO at night until she regained wrist and
finger active extension.
• Recently started to develop an elbow flexion contracture,
so we made her a custom elbow extension splint to wear
at night.
Case studies over an episode of care
• 13 month old girl with right hemiplegia
• Fisted position most of the time, otherwise wrist, elbow
•
•
•
•
and shoulder movement are good. Some neglect of her
right side.
Fitted with a McKie splint for her thumb
Fitted with a WHO for night
Pulling the splint off, splint modified with rivets on the
straps and stockinette over the splint.
Now 22 months and this continues to work for her
Acknowlegments
Patterson Medical (pictures zipper splint, Y strap
• Benik Corporation (pictures of Benik products)
• Exos (picture of Exos splints)
• Google images ( pictures of hands, kids)
•
Questions?