Aila Nica J. Bandong, PTRP University of the Philippines Manila College of Allied Medical Professions PT 150: Orthotics and Prosthetics
Mar 26, 2015
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?