Aila Nica J. Bandong, PTRP University of the Philippines Manila College of Allied Medical ProfessionsPT 150: Orthotics and Prosthetics

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

Orthotist Physician Social worker Psychologist Patient Physical Therapist Occupational Therapist

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

PERFORMANCEPERFORMANCE

HANDLINGHANDLING

Type• Static • Dynamic

Function• Flexion • Extension • Abduction • Adduction • Rotation

Region• Volar or Dorsal• Joints crossed * Finger / thumb splint * Wrist Splint * Wrist Hand Orthosis (WHO ) * Elbow (WHO) * Shoulder (Elbow- WHO)

ImmobilizeImmobilize or supportsupport

Help prevent prevent deformitydeformity

Prevent soft-tissue Prevent soft-tissue contracturecontracture

Allow attachmentattachment of assistive devices

BlockBlock a segment

C-Bar Connector bar CrossbarCuff or strap Deviation bar

and pan

Forearm troughAnatomic bars Thumb post Thumb troughBlocks

Hypothenar Bar

Lumbrical Bar

Metacarpal Bar

Opponens Bar

Lumbrical Bar Metacarpal bar

Deviation Bar

Forearm trough Metacarpal bar

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

Fractures Tendon injuries Crush injuries Amputation Arthritis Carpal tunnel

release Arthroplasty

Tendon transfer Tumor excision Reconstruction of

congenital defects Overuse

syndromes Cumulative trauma

disorders

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

Type Static or dynamic

Region Volar or dorsal Joint crossed

Function

Static Volar DIP Extension Splint

Static Three point orthosis for boutonniere deformity

Type Region Function

Static Dorsal Hand OrthosisWith an MP Block

Universal Cuff

Maintain the wrist in the neutral or mildly extended position

Immmobilizes the wrist while allowing full MCP flexion and thumb mobility

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

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

Immobilize to reduce symptom Position in functional alignment Retard further deformity

Forearm through

Thumb through

Pan

C-bar

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 )

Help stabilize CMC, MCP and IP joints

Thumb Post

•Volar Volar •Dorsal Dorsal •Radial Radial Gutter Gutter Opponens

Bar

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

Platform design Volar based platform Dorsal based platform

Finger and thumb position Finger spreader Cones

StaticDorsalElbowOrthosis

Balanced Forearm Orthosis

Forearm trough

Elbow dial

Rocker Assembly

Distal arm

Distal bearing

Proximalbearing

Bracket

Shoulder slings Humeral Fracture Brace

Airplane Splints

To substitute substitute for loss of motor function

To correctcorrect an existing deformity

Provide controlled controlled directional movementdirectional movement

Aid in fracture fracture alignmentalignment and wound wound healinghealing

Too great stretch Fatigued injury Failure

Too little stretch Atrophy and weaken Skin, tendons,

ligaments, and joint capsules will shorten in the absence of habitual tensile forces • Enough stretchEnough stretch

– Three degrees of gain in ROM per week, with a range of 1-10 deg, is acceptable (Cummings et al 1992 )

– High intensity short term stretching actually promotes stiffness

– The client should sense tension in the tissues but feel no pain

Hepburn, 1987 The stretch should not be perceived as a

“stretching” force until at least 1 hour has passed

Client should remain comfortable with the orthosis for up to 12 hours

After removal, the client should feel no more than a stiffness or mild ache

Outrigger Dynamic Assist Finger cuff Reinforcement bar Fingernail attachments Phalangeal bar/finger pan

Springwire finger coils

Springwire knuckle bender

Elastic bands

Finger

hooks

Contoured finger hooks

Dynamic finger extension splint Dynamic wrist extension splint Tenodesis training Dynamic ulnar nerve splint Capener Anti-microstomial splint

Dynamic radial nerve splint Objectives:

Immobilize the wrist in functional position

Passively extend the MCP to 0 Permit full active MCP flexion

and unrestricted IP motion Indications:

Paralysis of wrist, MCP, Finger extensors

Advantages: Relatively has a less obtrusive

shape as compared to the outrigger design

The hand can be slipped through a loose sleeve with the orthosis on

Finger Cuff

Dorsal Forearm Trough

Dynamic Springwire Assist

Objectives: Passively extends

the wrist while allowing wrist flexion

To prevent contracture of unopposed, innervated wrist flexors

Indication: Weak or paralyzed

wrist extensors

Metatarsal Bar

Dynamic Springwire Knucklebender Assist

Volar Forearm Trough

Rehabilitation Institute of Chicago

Objectives: To train tenodesis

grasp To promote a strong

tripod pinch with wrist extension

Allows finger opening with wrist flexion

Indication: C6 quadriplegia with

grade 3 strength of wrist extensors

Finger Cuff

Thumb Spica

Forearm Cuff

Dynamic Elastic Band Assist

Dynamic anti-claw deformity splint, Wynn Perry Splint

Objectives To passively flex the 4th

and 5th MCP’s To prevent shortening of

the MCP Collateral ligaments

To promote active IP flexion

Indication Ulnar nerve lesion

Metacarpal Bar Dynamic

Springwire Knucklebender Assist

Lumbrical Bar

Dynamic spring wire splint for PIP extension

Objectives: To passively extend

the PIP Allows active IP flexion Provide stability to PIP Promote restabilization

of lateral bands and prevent rupture of the central slip

Advantage “no, profile” minimizing

its visual presence

Indications- PIP flexion contracture- PIP dorsal dislocation- Volar plate injury- Flexor tendon repair with resulting PIP flexion contracture- Partial or complete tear of the collateral ligament- Boutonniere deformity

ThermoplastDynamic Springwire Finger Coil Assist

Objectives: To apply stretch to

tissues surrounding the oral cavity while permitting speech

To prevent contractures of lip and buccal tissues that may lead to limitation in oral opening

Indications: Facial and perioral burns

Wearing regimen Continuously worn Taken off only for

cleaning

Precaution The commisures(corners)

of the lips are prone to skin breakdown with improper fit and tension of the splint

Be aware of and make adjustments for pressure areas

Check for presence of edemaTimingComplianceSkin reactions

ANY QUESTIONS?