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Successful Splinting Series! Part 1 – Splinting Foundations

Dr. Kirsten Davin OTD, OTR/L, ATP, SMS

Copyright/Permissions § All images, charts, graphs, photos and other

assets in this PowerPoint are owned by Dr. Kirsten Davin and/or she has secured written permission to publish them on continued.com.

§ A special thank you to Performance Health, who provided images, charts and graphs for our educational purposes.

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§  Presenter Disclosure:  §  Financial: Kirstin Davin has received an honorarium for

presenting this course. §  Non-financial: Kirstin Davin has no relevant non-financial

relationships to disclose.

§  Content Disclosure: This learning event does not focus exclusively on any specific product or service.

§  Sponsor Disclosure: This course is presented by OccupationalTherapy.com.

Disclosures

Learning Outcomes After this course, participants will be able to: §  Describe the history of splinting, including two (2) factors

that contributed to the advancement of splinting techniques.

§  Name five (5) anatomical landmarks used in fabricating upper extremity splints, one or more issues related to inaccurate use of that landmark, and any additional contributing factors.

§  Identify three (3) characteristics of splinting materials and state how these characteristics may be utilized in the decision-making process as related to the splint fabrication process.

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History of Splinting/Orthotics

Q1/Q2

§  Evidence of orthotics in ancient Egypt §  Wars produced largest advancements §  Significant improvement within the last

50 years

Muhamed Ayman / CC BY-SA (https://creativecommons.org/licenses/by-sa/4.0)

See page for author / CC BY (https://creativecommons.org/licenses/by/4.0)

Anatomical Review of the Hand!Skeletal Features

OpenStax College / CC BY (https://creativecommons.org/licenses/by/3.0)

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Anatomical Review of the Hand!Muscular Features

§  Intrinsic Muscles §  Contained entirely within

the hand §  Ex. Opponens pollicis

§  Extrinsic Muscles §  Act on the hand, but

originate outside of the hand §  Ex. Flexor pollicis

longus Q3/Q4

Anatomical Review of the Hand!Arches

§  Longitudinal Arch §  Transverse Metacarpal §  Oblique Arches

§  Anatomy > Arches §  Arches > Function

§  Remember! Splinting must support, not alter normal anatomy

Q5

By Fama Clamosa - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=23508428

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Anatomical Review of the Hand §  Palmar Creases

§  Distal (transverse) §  Proximal (transverse)

§  Additional Landmarks §  Thenar eminence §  Hypothenar eminence

§  Splint Borders §  Palmar – Proximal to distal

crease §  Dorsal – Midpoint of creases

Q6

Splint Types!Static § Most common splint

type

§ No moving parts

§ Used to support, immobilize, rest, protect, reduce pain and/or prevent muscle shortening or contracture

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Splint Types!Serial Static

§ Position soft tissue toward the end of available range to increase tissue length

§  Low-load prolonged-stretch solution

§ No movable parts

§ Apply low-load prolonged-stretch to soft tissue via advancing static positioning to increase PROM

§ Gradual stretch

§ Option for compliant motivated patient

Splint Types!Static Progressive

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Splint Types!Dynamic

§ Static base onto which resilient components (rubber bands, springs, elastic cord) are attached

§  Increases PROM § Augments AROM by

assisting joint through the range

§ Accommodates for decreased ROM

§ Thickness

§ Conformity

§ Drapability

§ Memory

§ Resistance to Stretch

§ Perforation

Thermoplastics!Overview

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Q7

Thermoplastic Characteristics!Thickness

Q8/Q9

Thermoplastic Characteristics!Conformability & Drapability

§ Conformability §  Ability of the

thermoplastic to contour to anatomy

§  Beneficial when an intimate fit is required

§ Drapability §  Ability of the

thermoplastic to conform without assistance

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Thermoplastic Characteristics!Memory

§ Memory §  Ability of the thermoplastic to regain original shape

following heating

Thermoplastic Characteristics!Resistance to Stretch/Rigidity

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ResistancetoStretchHigh

LowConformabilityHigh

Thermoplastic Characteristics!Resistance to Stretch/Rigidity ~ A Comparison

Thermoplastic Characteristics!Perforation

§ Benefits §  Increased airflow

§  Reduced skin maceration

§  Lighter orthotic

§  Increased client satisfaction

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Q10

Thermoplastic Characteristics!Perforation

Putting it All Together § Considerations for splint/orthotic fabrication

§  Which region(s) of the anatomy require intervention? §  What is the objective of the intervention?

§  Protection after injury, Immobilization, etc. §  What qualities are required of the thermoplastic?

§  Drapability, perforation, rigidity, etc. §  Which thermoplastic will you choose?

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Questions? !Thoughts or Feedback?!On-Site Course Requests? Contact Dr. Kirsten Davin anytime!

§ Phone: 217.414.2585 § E-mail: Kirs10k@aol.com §  LinkedIn: https://www.linkedin.com/in/dr-kirsten-

davin-a459a274

References §  AOTA (n.d.). The unique role of occupational therapy in rehabilitation of the hand.

Retrieved from https://www.aota.org/About-Occupational-Therapy/Professionals/RDP/hand-therapy.aspx

§  AOTA Fact Sheet (n.d.). Occupational therapy’s role with rehabilitation of the hand. Retrieved from https://www.aota.org/~/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/RDP/Facts/Hand%20Therapy%20fact%20sheet.pdf

§  Baksa G., Mandl P., Benis S., Patonay L., Balint G.P., Balint P.V. (2018) Gross Anatomy of the Human Hand. In: Balint P., Mandl P. (eds) Ultrasonography of the Hand in Rheumatology. Springer, Cham. 15-41.

§  Jack, J., & Estes, R. I. (2010). Documenting progress: Hand therapy treatment shift from biomechanical to occupational adaptation. American Journal of Occupational Therapy, 64, 82–87.

§  Imran, K., et al. (2017). A Brief Overview of Shape Memory Effect in Thermoplastic Polymers. Smart Polymer Nanocomposites. Springer Series on Polymer and Composite Materials. https://doi.org/10.1007/978-3-319-50424-7_10

§  Lesher, D. A.-M., Mulcahey, M. J., Hershey, P., Stanton, D. B., & Tiedgen, A. C. (2017). Alignment of outcome instruments used in hand therapy with the Occupational Therapy Practice Framework: Domain and Process and the International Classification of Functioning, Disability and Health: A scoping review. American Journal of Occupational Therapy, 71, 7101190060. https://doi.org/10.5014/ajot.2017.016741

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§  Mohammad K., et al. Thermoplastic Sheet for Orthoses, A Review of Literature (2017). EC Orthopaedics. 189-193.

§  Roll, S. C., & Hardison, M. E. (2017). Effectiveness of occupational therapy interventions for adults with musculoskeletal conditions of the forearm, wrist, and hand: A systematic review. American Journal of Occupational Therapy, 71, 7101180010. https://doi.org/10.5014/ajot.2017.023234

§  Richards, T., Clement, R., Russell, I., & Newington, D. (2018). Acute hand injury splinting - the good, the bad and the ugly. Annals of the Royal College of Surgeons of England, 100(2), 92–96. https://doi.org/10.1308/rcsann

§  Smith, G. (1908). The Most Ancient Splints, Br Med J. 1:732. §  Wormald, J., Millar, C., & Sivakumar, B. (2018). An Eco-conscious Alternative Material for

Splinting in Hand Surgery. Techniques in Hand & Upper Extremity Surgery. 22(4); 156-157.

References