UPPER EXTREMITY ORTHOSIS (STATIC AND DYNAMIC)

1. Aila Nica J. Bandong, PTRP University of the Philippines Manila College of Allied Medical Professions PT 150: Orthotics and Prosthetics UPPER EXTREMITY ORTHOSIS(STATIC AND DYNAMIC)

2. Learning Objectives At the end of the session the students should be able to: • determine the classification used for upper extremity orthoses • determine diagnostic indications for upper extremity orthoses • determine the components and functions of upper extremity orthoses • discuss several static splints • describe dynamic splints • enumerate the purposes for prescribing dynamic splints • determine physiologic considerations in dynamic splints • determine the basic components and functions of dynamic splints • discuss several dynamic splints

3. Orthosis Clinic Team • Orthotist • Physician • Social worker • Psychologist • Patient • Physical Therapist • Occupational Therapist

4. Scope of Practice Occupational Therapy • Hand Rehabilitation • Maximize residual function of the patient who has had surgery to, or an injury or the disease of the upper extremity Physical Therapy • RA 5680 Section 16 • Assess the need to use assistive device and train patients as called for • Train patients to become functionally independent

5. Orthosis vs. Splint?

6. Characteristics of Thermoplasts HANDLING PERFORMANCE

7. Handling Characteristics

8. Performance Characteristics

9. Upper Extremity Orthosis Classification • Type • Static • Dynamic • Region • Volar or Dorsal • Joints crossed • * Finger / thumb splint • * Wrist Splint • * Wrist Hand Orthosis • (WHO ) • * Elbow (WHO) • * Shoulder (Elbow- WHO) • Function • Flexion • Extension • Abduction • Adduction • Rotation

10. STATIC SPLINTS

11. Purpose of Splinting: STATIC • Immobilize or support • Help prevent deformity • Prevent soft-tissue contracture • Allow attachmentof assistive devices • Block a segment

12. Basic Components • C-Bar • Connector bar • Crossbar • Cuff or strap • Deviation bar and pan • Forearm trough • Anatomic bars • Thumb post • Thumb trough • Blocks

13. Basic Components :C-bar

14. Basic Components: Connector bar

15. Basic Components: Cross bar

16. Basic Components: Cuff or Strap

17. Basic Components: Deviation bar

18. Basic Components: Pan and Thumb trough

19. Basic Components: Forearm trough

20. Basic Components: Anatomic Bars Hypothenar Bar Metacarpal Bar Lumbrical Bar Opponens Bar

21. Basic Components: Thumb Post

22. Basic Components: Blocks

23. Name the components Lumbrical Bar Metacarpal bar Forearm trough Metacarpal bar Deviation Bar

24. Upper Extremity Orthosis • Finger and thumb Orthosis • DIP • PIP • Hand Orthosis • Volar or dorsal hand orthosis • Universal Cuff • WHO • Cock - up splint • Resting hand splint • Thumb spica • Antispasticity splints

25. Diagnostic Indications • Fractures • Tendon injuries • Crush injuries • Amputation • Arthritis • Carpal tunnel release • Arthroplasty • Tendon transfer • Tumor excision • Reconstruction of congenital defects • Overuse syndromes • Cumulative trauma disorders

26. Treatment Goals • Prevent or decrease edema • Assist in tissue healing • Relieve pain • Allow relaxation • Prevent, misuse, disuse and overuse of muscles • Avoid joint jamming or injury • Redevelop motor & sensory function

27. Finger Orthosis ( DIP ) • Type • Static or dynamic • Region • Volar or dorsal • Joint crossed • Function Static Volar DIP Extension Splint

28. Finger Orthosis ( PIP ) • Static Three point orthosis for boutonniere deformity

31. Hand Orthosis • Type • Region • Function Static Dorsal Hand Orthosis With an MP Block

32. Hand Orthosis • Universal Cuff

33. Wrist Cock-Up Splint (WHO) • Maintain the wrist in the neutral or mildly extended position • Immmobilizes the wrist while allowing full MCP flexion and thumb mobility

34. Wrist Cock-Up Splint (WHO) Contraindications: • Active MCP synovitis • Joint inflammation resulting to volar subluxation and ulnar deviation Disadvantages: • Interferes with tactile sensibility on the palmar surface of the hand • Dorsal strap can impede lymphatic flow

35. Dorsal Wrist Cock-Up Splint • Stronger mechanical support of wrist and freeing up some of the palmar surface for sensory input • Distributes pressure over the larger dorsal wrist surface area • Better tolerated by edematous hand

38. Resting Hand Splint (WHO) • Immobilize to reduce symptom • Position in functional alignment • Retard further deformity

39. Resting Hand Splints (WHO) C-bar Forearm through Pan Thumb through

41. Special Considerations • For burns: make adjustments as bandage bulk changes • Preventing infection: when open wound has exudates, clean splints with warm soapy water, hydrogen peroxide, or rubbing alcohol • Patients in the ICU: use sterile materials; follow protocol of the facility • RA patients benefit from thin thermoplast ( less than 1/8 inch )

42. Thumb Spica Splint (WHO) • Help stabilize CMC, MCP and IP joints Thumb Post • Volar • Dorsal • Radial • Gutter Opponens Bar

44. EVIDENCE IN PRACTICE • A review of studies conducted by Oldfield and Felson (2008) regarding the effects of wrist orthotic device use on pain and functionality in patients with RA reveal that the splints improved wrist pain and functionality without compromising dexterity

45. Antispasticity Splints Platform design • Volar based platform • Dorsal based platform Finger and thumb position • Finger spreader • Cones

46. Upper Extremity Orthosis Static Dorsal Elbow Orthosis

47. Upper Extremity Orthosis Balanced Forearm Orthosis Forearm trough Elbow dial Distal arm Proximal bearing Rocker Assembly Distal bearing Bracket

48. Upper Extremity Orthosis Humeral Fracture Brace Shoulder slings

49. Upper Extremity Orthosis Airplane Splints

50. DYNAMIC SPLINTS