Foundations of Splinting

1. Foundations of Splinting

2. Definition of a Splint • Splint: An orthopedic device for immobilization, restraint, or support of any part of the body (Mosby 2002) • Orthosis: A force system designed to control, correct, compensate for a bone deformity, deforming forces, or forces absent from the body • Which one is the temporary?

3. History of Splinting • Started with carpenters and blacksmiths, used cloth, wood, leather and metal. • Prospered in World war II. • Development of LT thermoplastic materials – 1960s • American society for hand therapy (ASHT) association in 1977. • Exam – CHT

4. Splintmakers • OTs • PTs who specialize in hand rehabilitation • PTs often fabricate splints for the lower extremity • Certified orthotists • Experience in splinting

5. Frameworks for Splinting • OTPF, includes Performance areas (ADL, IADL, education, work, play leisure and social participation • Performance areas makes a demand on performance skills (motor, processing, communication skills… etc.) • Consider the influence on performance patterns (habits, roles and routines) • Never forget the context (cultural, physical, social, personal, spiritual, temporal and virtual dimensions)

6. Frameworks for Splinting • Activity demand, includes object uses, space demands, social demands, sequencing, and timing. • Client factors, a persons body functions and body structure • Have a look at the example table page 5

7. Approaches for splinting • Rehabilitative: Tenodesis splint • Biomechanical: dynamic splint • Sensorimotor: antispasticity • Quiz 1-1

8. Which approach are we using here? • Child with CP, the goal is to decrease the amount of tone present? • The goal is trying to regain full Range of Motion, what is the approach used? • The goal of this splint to assist with this grasp to be able to hold the walker?

9. Splint Design Previously splints were divided into static or dynamic splint Static splint have no moving parts, it places the tissue in a stress- free position to enhance healing and minimize friction Dynamic splints have one or more moving parts, they include elastics, wires, springs…etc.

10. Splint Design The therapeutic interventions of splinting includes: Static Serial static Dynamic Dropout splint

11. Static splints Maintain a position to hold anatomical structures at the end of available ROM, thus exerting a mobilizing affect on the joint

12. Serial static splinting Remodeling of a static splint Hold the joint at a tolerable degree of ROM, thus promoting tissue remodeling

13. Dynamic/ Elastic tension/ mobilization splints They have self adjusting or elastic components (wires, rubber band, springs)

14. Dropout splint Allows motion in one direction while blocking motion in another

15. Splint Design Many possibilities exist for splint formation You need to be creative and have high skills of clinical reasoning to determine what is the best splint/ fabrication implications are.

16. Splint categorization • There are 6 splint classification divisions: • Identification of articular or nonarticular • Location • Direction • Purpose • Type • Total number of joints

17. Expanded splint classification system Splint Articular Nonarticular Location Location Direction Mobilization Restriction Torque transmission Immobilization Type Type Type Type

18. Identification of articular or nonarticular • Articular splints use three point pressure systems • It affects a joint or joints by immobilizing, mobilizing, restricting, or transmitting torque • Most splints are articular so you do NOT mention it in the name of the splint • Nonarticular splints use two points pressure force to stabilize or immobilize a body segment • The term nonarticular should ALWAYS be included in the name of splint (used in long bones of the body i.e. humerus)

19. Location • Splints are classified according to their primary anatomical part • So, in articular splints you will mention the joint name, like elbow, thumb, MP…etc. • Whilst in nonarticular splints you will mention the name of the long bone, like ulna, radius…etc.

20. Direction • It is only applicable for articular splints only • It refers to the primary kinematic function of a splint • Examples like flexion, extension, and opposition are used to classify the direction of these splints • You would name a splint that is designed to flex the PIP joints of index, middle, wing and small fingers would be: index-small finger PIP flexion splint

21. Purpose • There are four purposes of splints: • Mobilization: move or mobilize primary or secondary joints • Immobilization: immobilize primary or secondary joints • Restriction: limit a specific aspect of joint range of motion for primary joints • Torque transmission: a. create motion of primary joints situated beyond the boundaries of the splint itself b. harness secondary driver joints to create motion of primary joints that maybe situated longitudinally or transversely to the driver joint • The purpose of the splint indicates how the splint works. • Example: Elbow immobilization splint

22. Type • The type of the splint specifies the secondary joints included in the splint. • Secondary joints are often incorporated in the splint design to affect joints that are proximal, distal, adjacent to the primary joint. • There are 10 joints in the upper extremity (shoulder, elbow, forearm, wrist, Finger MPs, finger PIPs, finger DIPs, thumb CMC, thumb MP, thumb IP) • We only count the joint LEVEL (not number) • Example, wrist + 3 PIP’s  2 level splint, so the name would be: index- small finger MP flexion mobilization splint type 2. • If no secondary joint are included, the level type would be type 0

23. Total number of Joints • It follows the type indication • Example, An elbow splint that includes the wrist and MPs would be called: “elbow flexion immobilization splint type 3 (4)

24. Question?