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Radomski, Ch 16 and 17
OT 624
Orthotics and
Jennifer Boyette, OTR, CHT, CEAS III, PhD
FOR for splinting and orthosis
 Biomechanical
Uses principles of kinetics and forces acting
on the body
 Sensory
motor FOR-
Used to inhibit or facilitate normal motor
 Rehabilitation
Facilitates maximal function
Defining terms
 Orthosis
Any device applied to or around a body
segment to address physical impairment or
Brace and support are terms used for an orthosis
A force system designed to control, correct, or
compensate for a bone deformity, deforming
forces, or forces absent from the body
Refers to a permanent device to replace or
substitute for loss of muscle function
Wrist hinge orthosis
 Device
for immobilization, restraint, or
support of any part of the body.
 Usually thought of as more temporary
than and orthosis
 ASHT splint classification
Static splint
Serial Static splinting
Static Progressive splints
Dynamic Splints
Health professionals who deal
with splinting and orthotics
 OT’s/
 CHT’s (can be PT or OT)
 Dentists
 Less common- nurses
Orthotic selection
 What
is the clinical or fxl problem?
 What are the indications for and goals of
splint use?
 How will orthosis affect the problem and
the client’s function?
 Benefits of splint/orthosis?
 Limitations?
 Custom made vs. pre-fab vs. no device
Splint related factors to
 Type
 Design
 Purpose
 Fit
 Comfort
 Cosmetic
 Weight
 Cost
to purchase
vs. fabricate
 Ease of care
 Durability
 Ease of donning
and doffing
 Effect on
unsplinted joints
 Effect on function
Patient-related factors
 Clinical
 Functional status
 Attitude
 Lifestyle
 Preference
 Occupational roles
 Living envio
 Working envio
 Social
 Issues related to
safety and
 Ability to
understand and
follow through
 Insurance and
financial issues
Purpose of orthosis
 Support
a painful joint
 Immobilize for healing
 Provide stability and restrict unwanted motion
Purpose of orthosis
• Restore mobility-drop out cast,flexion
glove, dynamic ext splint
• Substitute for weak or absent musclesMAS, eltoid aide, flexion assist spring,
tenodesis splint, WDWHO, ratchet brace
• Prevent contractures or Modify tone- air
splint, ball splint, neoprene thumb loop, wt.
bearing splint
Safety precautions for orthosis
 Impaired
skin integrity
 Pain
 Swelling
 Stiffness
 Sensory
 Increased stress on unsplinted joints
 Functional limitations
Purpose of splints
 Static
 Rest
 Prevention
of further deformity
 Prevention of soft tissue contracture
 Substitution for lost motor function
 Dynamic
 Substitution
for lost motor function
 Correction of a deformity
 Control of motion
 Aid in alignment and wound healing
Types of Splints
 Static
 Drop-out
 Articulated splints
 Self adjusting or elastic components
 Static progressive
Hinges, velcro, turnbuckles
 Serial
static or casting
Anatomical considerations
 Landmarks
Distal IP creases
Proximal palmar crease
Thenar crease
Wrist crease
Styloids, MP joints, IP joints, CMC, IP of Th
Anatomy (continued)
 Arches
of the hand
Distal transverse
Proximal transverse
 Fingers
flex toward scaphoid
 Functional position of hand
 Position of safe immobilization- intrinsic
plus position
Influence of splinting on tissue
 Inflammatory
phase- use splint to
immobilize and protect
 Fibroplastic phase: use splints to mobilize
healing tissues while protecting
 Maturation phase: low load force may be
applied gradually increasing the stress
Tissue Remodeling
 Ideal
tissue remodeling occurs with
gentle elongation of tissues (dynamic
and serial splinting/casting)
 Total end range time suggests that the
amount of increase in PROM of a stiff jt
is proportional to the time joint is held
at end range (serial static
 Stress relaxation or static progressive
stretch therapy
Mechanical principles applied
to splint design
 Increase
the area of force application to
disperse pressure
 Increase the mechanical advantage to
reduce pressure and increase comfort
 Ensure three points of pressure
 Add strength through contouring
 Perpendicular traction for dynamic
 Acceptable pressure for dynamic splinting
 High vs. low profile outriggers
Other considerations for
 Compliance
Offer options
Educate about benefits
Provide easy application and removal
Lightweight material
Immobilize only joints being treated
Cosmetically pleasing
Collaborate w/pt on wearing schedule
 Education
Construction of Hand Splints
 Purposes:
Positioning for function
Immobilization for healing
Restriction of undesired motion
Correction or prevention of deformity
Substitution of absent or weak muscles
Construction of a hand splint
 Design splint
 Select material
 Make pattern
 Cut splinting material
 Heat splinting material
 Form splint
 Finish edges
 Apply straps, padding and
 Evaluate the splint for fit and comfort
Materials and their properties
 Low temperature thermoplastic
 High temperature thermoplastics
 Metal braces and parts
 Soft splints
 Properties of materials
Self-finishing edges
Time to heat
Performance characteristics of
materials for splinting
 Conformability
 Flexibility
 Durability
 Rigidity
 Perforations
 Finish,
colors, and thickness
Pattern Making
 Tracing the hand
 Marking landmarks
 Cutting pattern
 Fitting pattern on client
Forearm splint should go 2/3rds up forearm and
trough should be ½ around the forearm. Should
not restrict DPC if splint goes into hand, doesn’t
restrict fingers
 Adjusting pattern
 Refitting
 Tracing pattern onto
Cutting and molding a splint
 Cutting
 Soften material
 Mold material on client
 Padding if needed prior to molding or
 Adjusting
 Reheating
 Strapping
 No
vs. spot heating
tourniquet effect
 Wider distributes pressure better
Dynamic Splinting
 Learning
Objectives: After this session,
the learner will:
Explain the purposes of dynamic hand
Be able to identify the line of pull for
muscles and joints in the UE
List common pressure areas with dynamic
Fabricate a dynamic flexion or extension
Purposes of Dynamic Splinting:
 Definition-
The application of a moving
part of a force which remains
approximately constant as the part
 Purpose: To give MOBILITY to a joint,
muscle, tendon, etc... (as opposed to
static splinting, which is designed to
Joint MOBILITY can:
Decrease adhesions
maintain joint function
promote tendon gliding
Uses of Dynamic Splints:
Skeletal Substitution
 aides in alignment
 supports bones and joints
Muscle Balance
 paralyzed muscles
 divided tendons or muscles (as in tendon transfers)
Joint Motion
 preserve or increase joint motion
 promote wound healing
 treat infection
 relieve pain
Parts of Dynamic Splints
Static Base
 Serves as the foundation for the splint, it:
 provides alignment
 provides the foundation for the outrigger
 provides the foundation for a hinge
 aides in relaxation of a spastic muscle
 allows tissues to adapt to new position
 protects a newly repaired structure
 provides proximal support
 aides in positioning and edema control
Dynamic Component
 Can be slings, ratchet, springs, elastic bands, hinge
 These features give the splint its MOBILITY
Benefits of Dynamic Splinting:
Constant or longer duration of steady tension is more
successful than vigorous passive exercise for 20 minutes
(especially where contractures are present)
Early motion=more effective healing
 increased circulation
 decreased edema due to increased pumping of
stagnant fluids
 increased gliding of tendons
 increased flushing of synovial fluids
 decreased adhesions
Can be used to introduce exercise more gradually and
insure that the patient is doing exercise in good alignment
Using Exercise with Dynamic
Aides in :
 Joint excursion
 tone of skin
 increased circulation
Increased patient confidence by seeing to what degree the
hand can be moved safely
Because part is supported proximally, patient can do
exercise more independently and more safely
Therapist should instruct patient not to go the the point of
Where there is decreased sensation, one must be extremely
careful to avoid pressure or push too rapidly
Heat prior to exercise may promote increased movement
Medical/Biomechanical Principles:
Moving muscles must be given an opposing,
balance force in order to maintain joint mobility
and tendon gliding
Movement prevents joint/muscle atrophy and
limits deformity
Joints should never be immobilized needlessly
Where the injury is on the flexor surface, wrist and
fingers should be placed in flexion.
Where the injury in on the extensor surface, wrist
and fingers should be placed in neutral or resting
Edema should be decreased ASAP
Strapping or construction of a splint should not
constrict venous return
Has a high protein content which congeals around the
hand structures, joint capsules, collateral ligaments, and
other fibrous structures
When these structures are surrounded by edematous fluid,
the tissues swell, thicken, and shorten and become and
unyielding fibrous tissue
The best program for edema is motion and elevation
Swollen fingers tend to go into hyperextension and the
thumb into adduction
Has a high protein content which congeals around the
hand structures, joint capsules, collateral ligaments, and
other fibrous structures
When these structures are surrounded by edematous fluid,
the tissues swell, thicken, and shorten and become and
unyielding fibrous tissue
The best program for edema is motion and elevation
Swollen fingers tend to go into hyperextension and the
thumb into adduction
Edema is more common in the dorsum of the hand where
the skin allows more fluid to accumulate
In the palmar surface of the hand, edema causes the
arches to become flattened and hence clients have
difficulty making a fist
Splint strapping, when applied too tight, can worsen edema
due to decreased blood flow
Edema can also be aided by removal of a splint every two
hours and allowing range to the unaffected joints
Patient Education:
 Patients
should be educated in:
purpose of the splint
 accurate positioning of the splint
 what motion or range is being sought
 simple anatomy and mechanism of
injury / surgical repair
 specific wearing instructions that
 wearing
 placement of splint and strapping
 common pressure areas
 exercises allowed while in (or out of ) splint (if
Hand Architecture
 Directional
Pull of the fingers:
All the fingers , excepting the middle finger (which
may flex straight down) cross the palm obliquely from
10-30 degrees
 Anatomical
center of the Hand:
is located at the level of the head of the third
 To
find this point, converge all five fingers at one point
with the fingers forming a cone
 Distal
 Proximal Row
Interphalangeal joints
The Mechanics of Splinting
 Addition of forces
 two or more forces acting upon an object
may be added and be replaced by a single
force which is their sum
 Transmissibility of a force
 A force acting on a rigid body may be
considered to have a point of application
anywhere along its line of action
The Mechanics of Splinting
 Equilibrium
 If the forces and the torque applied to a
body add up to zero the body will remain at
 Action and Reaction
 The interaction between two bodies in
contact may be represented by two forces
equal in magnitude and opposite in direction
having the same line of action
 the
horizontal component of the force applied
along the cuff of a dynamic splint when it pulls
along the surface of the skin is called friction
 Friction is an unreliable force and splints should
not be designed to depend upon friction for
maintenance of a position. As patients move,
slippage of cuffs and splints is bound to occur
 Therapists should attempt to reduce friction
effects as much as possible
 One should assume that skin is essentially
frictionless and it should not be depended on
during splint design
Tension and Compression Rubber
bands, velcro strapping can have
traction effects, the weight of the tension
needs to match the weight of the
extremity being placed in tension. For
example, If a rubber band is too tight or
too loose, it will not match the weight of
the extremity and hence not have the
desired effect
 Compression forces are those that
squeezed together - A splint with a hinge
on it might have this effect if it acts to
hold two parts together, but still allows
Balancing forces
 Equilibrium
of a splint- all forces should balance
out within a dynamic splint if the splint is not to
cause problems (such as friction, shearing,
pressure areas)
 Equilibrium of axial forces- Horizontal forces in a
splint must = zero. If a hand presses against a splint
and thus cancels out the horizontal force of a
rubber band, the horizontal forces can be at
 Wedging- changes the forces from small to large
by changing the distribution of the force over a
larger space. This increases the chance of
pressure areas if the wedge is not widely
distributed over the skin.
Common pressure points
 MP
 IP joints
 Ulnar styloid
 Center of the palm
 Any surface on which a finger cuff
or traction bar exerts a force
 Web space
 Dorsal-lateral aspect of the thumb
Documentation about
 Document
why client needs splint
 Position that client was splinted in
 Instructions you gave client
 Follow up needed
Splinting Lab