SPLINTING FOR POSITION AND FUNCTION. Alyssa Dahlheimer, OTR/L, CHT

Transcription

1 SPLINTING FOR POSITION AND FUNCTION Alyssa Dahlheimer, OTR/L, CHT

2 Objectives Determine when and why to splint in pediatric populations Which types of splints work well for various purposes (different joints, day/night, prefabricated or custom)

3 Why splint? Keep muscles, tendons, ligaments, stretched and extensible when unbalanced muscle tone is present Position a joint for increased function Protection In pediatrics, dealing with growing bones and if the muscles do not elongate with the bone, a contracture will result.

4 Splinting patients with unbalanced muscle tone Cerebral Palsy, Traumatic Brain Injury, Stroke, Brachial Plexus injury, SCI Wrist hand orthosis Made out of a double layer of Ezeform Typically worn at night, leave hand free during the day

5 Splinting patients with unbalanced muscle tone Y-strap (Patterson medical), comes in a variety of sizes.

6 Getting the right fit-who 2/3 length of the forearm Circumference-about ½ Palmar arches Thumb position Wrist in about 20 degrees extension Smooth edges Strapping

7 WHO with elastomer Can add this to splint for added positioning/stretch, scar management.

8 Prefabricated wrist hand orthosis Benik with volar pan RCAI Comfy

9 Gradually increasing the stretch FDS and FDP cross the wrist, so the amount of stretch at the fingers is dependent on the position of the wrist.

10 Wrist splints: positioning for function (and to prevent deformity) Lots of options!

11 Wrist splints: positioning for function (and to prevent deformity) Benik wrist with metal stays Benik wrist with metal stay and neoprene thumb

12 Wrist splints: positioning for function (and to prevent deformity) Thermoplastic wrist with neoprene thumb Thermoplastic wrist and thumb

13 Wrist splints: positioning for function (and to prevent deformity) Benik custom order

14 Custom-made wrist splints Radial bar/wrist cock-up

15 Pre-fabricated wrist splint options Exos splint

16 Pre-fabricated wrist splint options Zipper splint

17 Getting the right fit-wrist splints Allow MCP flexion, fit just proximal to the distal palmar crease. 2/3 length of forearm Ulnar styloid If splint includes thumb abduction, usually want to leave the thumb IP free. If splint does not include thumb, make sure patient can perform thumb opposition

18 Splints to position the thumb McKie splints

19 Splints to position the thumb Benik thumb abduction splint (BD-88)

20 Splints to position the thumb

21 Custom thumb spica

22 Getting the right fit-thumb splints IP free Allow wrist flexion and extension

23 Elbow extension splints Custom made

24 Elbow extension splints Comfy splint RCAI

25 Getting the right fit-elbow splints More surface area reduces pressure points (splint and straps) Use leverage ½ circumference of the arm for custom

26 Ideas for compliance Add iron on decals to the neoprene splints Patient chooses strapping color Patient chooses color on custom order Talk about why the splint is important For younger patients, put the splint on when they are already asleep.

27 Ideas for compliance rivets

28 Wearing Schedules Gradually increase wear time Check for red marks (30 minutes) If bilateral splints, can alternate wearing every other night Make sure family understands how to wash/dry them

29 Case Studies over an episode of care 4 year old girl with hemiplegic cerebral palsy (left side) Nice active shoulder and elbow motion Her wrist, fingers and thumb are in flexion most of the time (thumb collapse) Can actively extend wrist to almost neutral, can extend fingers about ½ range, little thumb active motion. Has come to OT on/off for a few years and tried several splints (custom WHO, Benik wrist with neoprene thumb, McKie thumb)

30 Case studies Before discharge she started to figure out synnergistic movement patterns (wrist flexion to extend fingers, wrist extension to flex fingers) Which splints she was using at discharge: RCAI wrist hand orthosis (she liked because of padding and it worked because she has PROM that allows her to wear it) Exos thumb spica splint (needed high stability and skin reaction to neoprene), also did not want to block wrist

31 Case studies over an episode of care 10 month old boy with Arthrogryposis Bilateral position of elbow flexion, wrist extension, thumb IP flexion, thumb adduction, MCP flexion. Started out with wrist hand orthosis, had to position his thumbs in radial abduction rather than palmar due to passive range of motion. Splints went as far to elbow as possible to balance out wrist extension. Mckie newborn size thumb abduction splints for daytime. Came in 1x/month for splint modifications, increase wrist flexion toward neutral.

32 Case studies over an episode of care Now his wrists are at neutral, continuing to wear at night Recently made elbow extension splints (family as been doing PROM), can come to 90 degrees. Initial plan was to alternate right WHO/left elbow splint with left WHO/right elbow splint every other night. Could not sleep with elbow splints on, moved to trying to get a couple of hours of time in elbow splints during the day. Transitioned from McKie to a thermoplastic Benik thumb abduction splint because he was overpowering the Mckie.

33 Case studies over an episode of care 7 year old girl with a birth brachial plexus injury At birth, demonstrated limited movement in wrist and finger extension, elbow flexion, shoulder flexion, abduction, external rotation. She wore a WHO at night until she regained wrist and finger active extension. Recently started to develop an elbow flexion contracture, so we made her a custom elbow extension splint to wear at night.

34 Case studies over an episode of care 13 month old girl with right hemiplegia Fisted position most of the time, otherwise wrist, elbow and shoulder movement are good. Some neglect of her right side. Fitted with a McKie splint for her thumb Fitted with a WHO for night Pulling the splint off, splint modified with rivets on the straps and stockinette over the splint. Now 22 months and this continues to work for her

35 Acknowlegments Patterson Medical (pictures zipper splint, Y strap Benik Corporation (pictures of Benik products) Exos (picture of Exos splints) Google images ( pictures of hands, kids)

36 Questions?