the four goals of UE splinting
- protective
- supportive
- corrective/progressive
- functional
is “splint” an outdated term
yes
is “orthosis” an outdated term
no
two general types of splints
static and dynamic
Static of Dynamic:
moveable parts are incorporated into the design of the brace and may include hinges, rubber bands, outriggers, or finger slings
dynamic
Static or Dynamic:
no moveable parts and the involved part of the UE are positioned in a functional posture
Static
are static splints worn intermittently or constantly
intermittently
when are dynamic splints generally used
frequently used to maintain function and mobility while specific joints are supoprted
type of sling where there is an “X” on the back
Figure 8 Sling
what is the typical UE position in an arm sling
adduction
IR
slight flexion
3 indications for arm sligns
- humeral fracture
- bone repair
- rotator cuff injury
when might an arm abduction orthosis be indictated
for patients with chronic GH dislocation
what is another name for an arm abduction orthosis
adduction control orthosis
OR
airplane orthosis
what is the typical design of an arm abduction orthosis
support medial arm, weight borne on iliac crest or lateral trunk
what is the purpose of a balanced forearm orthosis (3)
- supports arm
- assists weak proximal mesculature (weak/low tone)
- dampen control for increased tone
what are the functional benefits of using a balanced forearm orthosis
improve functional independence in performing tabletop skills (eating, writing, operating keyboard)
how does the balanced forearm orthosis work
uses shoulder or scapular movement to control elbow
what does BFO stand for
Balanced Forearm Orthoses
who is BFO appropriate for
individuals with SCI, polio, brachial plexus injury, MD, Guillian Barre
what is the appropriate placement of an epicondylar strap
applied circumferentially to forearm, distal to epicondyles
how does the epicondylar strap work
provides compression over muscle/tendon, reducing muscular forces on osteotendinous junction by redirecting the line of pull
what are indications for an epicondylar strap
inflammation at junction of flexor or extensor tendons at osteotendinous attachment
the hand is a two part unit… the ____ and ____ side
radial and ulnar side
the radial part of the hand includes…
the thumb, index, and middle fingers
the ulnar part of the hand includes
the ring and little finger
what part of the hand is designed for mobility and functional grasp
radial
what part of the hand is designed for stability
ulnar
the three types of prehension graps
- pinch
- lateral pinch
- three-jaw chuck
what prehension is 60% of all ADL skills
three-jaw chuck
what are the two types of grasp
- spherical
2. cylindrical
throwing a ball is most like this type of grasp
spherical
holding groceries is most like this type of grasp
cylindrical
what is the functional position of the wrist/hand
wrist MCP PIP DIP thumb
wrist 30 extension
MCP 45-50 flexion
PIP 30-45 flexion
DIP slight flexion
thumb opposition and abduction
what is the resting position of the wrist/hand
wrist MCP IP thumb CMC thumb MCP
wrist 20 extension
MCP 70-90 flexion
IP 30-45 extended
thumb CMC abducted
thumb MCP extended
what is the purpose in a resting hand orthosis
protect, support, correct alignment
what is the alignment in a resting hand orthosis
wrist and hand positioned in resting position
three indications for resting hand orthoses
- arthritis
- hemiparesis
- polio
- burns
- contractures
what is the position of the wrist in wrist cock-up splint
extension
what is the general characteristics of the MPs in a wrist cock-up splint
MPs are supported bu allow some movement
what is the general characteristics of the IP joints in a wrist cock-up splint
IP joints are allowed unrestricted movement
what is the purpose of a wrist cock-up orthosis (2)
- support wrist during acute phase of healing
2. increase functional independence secondary to weakness by improving hand function
three indications for a wrist cock-up splint
- carpal tunnel
- flex/extension tendonitis
- lat/med epiconylitis
- wrist strain/sprain
- brachial plexus injury
what is the purpose of a tone reduction orthosis (3)
used to:
- decrease flexor tone
- increase ROM
- prevent skin breakdown
where is the thumb placed in a short opponens orthosis
thumb placed in abduction to promote function
what is the length of the short opponens orthosis (anatomically)
IP joint of thumb to base of thumb
what is cleared in the short opponens orthosis
the thenar crease
what are 3 indications for short opponens orthosis
- CMC/MCP arthritis
- fracture
- subluxation
- dislocation of thumb
- ligament repair
what is the design of a long opponens orthosis-thumb spica
same design as short opponens but extends across wrist to forearm
for long opponens orthosis-thumb spica, what is the position of the wrist
some extension
what are general indications for a long oppenens orthosis
when the pathology involves thumb and wrist
how does a tenodesis orthosis work
with active wrist extension, wrist flexors are put on stretch causing finger flexion
for tenodesis orthoses, individuals learn to use the finger flexion movement for…
function
what is a way to correct a swan neck or boutonniere deformity
ring orthosis
what is the purpose of a dynamic orthosis
used to promote motion of certain segments while protecting or limiting motion at other segments
what are three indications for elbow or wrist mobilization orthoses
- maintain/protect range, improve ROM
- flexion contractures at elbow, wrist, hand
- scar release, trauma, burns
