Week 9: Splinting on UE Flashcards
(34 cards)
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
Dynamic splints
Types of splints?
Dynamic splints
Static
Serial Static
Static Progressive
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
Static
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
Serial Static
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
Static progressive splint
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
Restrictive splints
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)
Immobilization splints
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
Mobilization splints
Design of splints?
single surface, circumferential, or three-point design
____ is limited to acting on finger IP joints by providing loop of material that wraps around joints to restore final degrees of joint flexion.
loop
____ 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
single surface splinting
____ 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
circumferential splinting
What to look for if considering splinting
Compliance issues
Ability to don and doff a splint
Skin tolerance and hypersensitivity
Wearing schedule
Resistance to stretch
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
Conformability or drape
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
Memory
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
Rigid v. Flex
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)
Bonding
Ability of material to adhere to itself when warmed and pressed together
Uncoated materials have very strong bonding properties
self sealing edges
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
soft splint material
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
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
Forearm-based and hand-based splints
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
Large upper and lower extremity splints
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
Circumferential splints
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
Serial splints
