Figure 9-7 Dorsal-based resting hand splint: (A) dorsal view, (B) volar view. A disadvantage is that customization may require more of the therapists time to complete the splint and may be more costly. A resting hand splint is a static splint that immobilizes the fingers and wrist. According to Richard et al. However, individuals with complete spinal cord injuries may not have the same expectations of recovery, but can still benefit from an exercise program to move their upper extremity through full range of motion. It is typically formed or fitted by a hand therapist, who is an occupational or physical therapist with specialized training in treating the upper extremity. Figure 9-5 The components of a resting hand splint are the forearm trough, pan, thumb trough, and C bar. For persons who have hand burns, therapists do not splint in the functional position. The intrinsic plus position is otherwise known as the safe position for hand splinting. The thumb may or may not be immobilized by the splint. Undo all Velcro straps on the splint and place in front of the patient's weak arm. Tenodesis splints are designed to help tighten the soft tissues of the hands that become loose when the muscles are not working properly. For example, damage to the spinal cord can result in paralysis or immobility, depending on the severity andlevel of injury. A therapist can customize a resting hand splint by making a pattern and fabricating the splint from thermoplastic material. Kits are available according to hand size (i.e., small, medium, large, and extra large). Apply knowledge about the application of the resting hand splint (hand immobilization splint) to a case study. This is why when a hand or wrist is being casted or splinted, care is taken to put it in the position that will minimize stiffness. When the volar surface of the forearm must be avoided because of sutures, sores, rashes, or intravenous needles, a dorsally based forearm trough design is frequently used (. The resting hand splint has three purposes: to immobilize, to position in functional alignment, and to retard further deformity [Malick 1972. When splinting a joint with chronic RA, the rationale is often based on biomechanical factors. Intrinsic Plus Splint Surgical Management Excision and grafting Split thickness 0.012in sheet graft -Optimal durability -Function: Reduced Secondary healing -Optimal aesthetics Dorsal: 0.012" Palmar: 0.015-0.018" -Full thickness glabrous if available Split Thickness Graft Full Thickness Skin Graft Local Rotation Flap The therapist has control over joint positioning. Emergent Phase The dorsal skin of the hand will maintain its length in the antideformity position. In addition to splint intervention, persons with RA benefit from a combination of management of inflammation, education in joint protection, muscle strengthening, ROM maintenance, and pain reduction [Falconer 1991, Compliance of persons with RA in wearing resting hand splints has been estimated at approximately 50%, [Feinberg 1992]. However, therapists may recommend them for specific functional activities while also reminding survivors to be mindful when using long opponens because they can interfere with wheelchair operation. An advantage of premade splints is their quick application (usually only straps require application). Therefore, to improve movement and coordination, survivors must practice high repetition ofhand exercises for spinal cord injury. Figure 9-2 This resting hand splint positions the hand in an antideformity position for individuals with hand burns. This splint is based on a resting hand splint design and is often used for individuals with rheumatoid arthritis. Below we have listed the most effective and commonly prescribed by therapists. ), Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window). Figure 9-6 Volar-based resting hand splint: (A) side view, (B) volar view. For children, splints are removed for exercise, hygiene, and play activities [deLinde and Miles 1995]. 7Determine a resting hand (hand immobilization) splint-wearing schedule for different diagnostic indications. The thumb may or may not be immobilized by the splint. Volar-based resting hand splint: (A) side view, (B) volar view. To wear it, place the thumb into the cut-out. Get a free copy of our ebook Rehab Exercises for Spinal Cord Injury Recovery. Extra long wrist strap maintains proper position while applying gentle . Hand Immobilization Splints The degree to which a persons compliance with a splint-wearing schedule affects the disease outcome is unknown. For a person who has severe deformities or exacerbations from arthritis, the resting hand splint may also position the wrist at neutral or slight extension and 5 to 10 degrees of ulnar deviation [Geisser 1984, Marx 1992]. (OBQ08.238) The C bar keeps the web space of the thumb positioned in palmar abduction. From the radial side of the splint, the thumb, the web space, and the digits should resemble a C (seeFigure 9-6). Depending on the severity of your spinal cord injury, there may be hope for improved mobility. Use clinical judgment to evaluate a fabricated resting hand splint (hand immobilization splint). Other times, a ready-made splint will be used. Until now, therapists had only one choice. In addition, when a resting hand splint pattern is cut out of perforated thermoplastic material it is difficult to obtain smooth edges because of the likelihood of needing to cut through the perforations (which causes a rough edge). Limb elevation is crucial, and care must be taken to avoid applying compressive dressings such as Ace wraps or restrictive circular casts. Forearm troughs can be volarly or dorsally based. This extension allows the entire thumb to rest in the trough. Figure 9-1 This splint is based on a resting hand splint design and is often used for individuals with rheumatoid arthritis. For persons who have hand burns, therapists do not splint in the functional position. Tenodesisgrasp and release is a mechanism that most individuals have naturally. Rolyan's New Look. The curved sides add strength to the pan and ensure that the fingers do not slide radially or ulnarly off the sides of the pan. The thumb may be positioned midway between radial and palmar abduction to increase comfort. The therapist should apply biomechanical principles to make the trough about two-thirds the length of the forearm to distribute pressure of the hand and to allow elbow flexion when appropriate. Splints can either bedynamic, meaning they allow movement, or they can bestaticwhich means they are in a fixed position. Some of the commercially sold resting hand splints are prefabricated, premolded, and ready to wear. Dorsally based forearm troughs are located on the dorsum of the forearm. The therapist has control over joint positioning. A splint can be recommended by a physician or a rehabilitation therapist. Long opponens splints helpmaintain web space(area between the thumb and index finger) but are used less frequently than other splints. Serial resting hand splints for persons with burns should conform to the person, rather than conforming the person to the splints [deLinde and Miles 1995]. When a great amount of forearm support is desired, a volarly based forearm trough is the best design (Figure 9-6). Hand Therapy and Splinting. An advantage of using a kit is the time the therapist saves by elimination of pattern making and cutting of thermoplastic material. Graduate occupational therapy students participated in timed trials fabricating resting hand splints with QuickCast and Ezeform brands of thermoplastic. Finger spacers may be used in the pan to provide comfort and to prevent finger slippage in the splint [Melvin 1989]. Resting Hand Splint Application The purpose of a hand splint is to: 1. properly position and protect the affected hand; 2. protect the joints and prevent contractures; and 3. decrease risk of swelling. Lau [1998] compared the fabrication of a resting hand splint with use of a precut splint, the QuickCast (fiberglass material) with Ezeform thermoplastic material. To rest the wrist and hand joints, the resting hand splint positions the hand in a functional or mid-joint position [Colditz 1995] (Figure 9-8). Survivors may experience weakness or lack of mobility in the hands, which limits the ability to perform daily tasks. Several diagnostic categories may warrant the provision of a resting hand splint. The biggest plus point is, you can use this device anywhere, anytime with precise exercises that you need and also saves your money and time spent on your physiotherapist.. Bend-to-fit construction allows easy modification without heat or tools even at the difficult to fit thumb. A resting hand splint kit typically contains strapping materials and precut thermoplastic material in the shape of a resting hand splint. 2005]; and tenosynovitis [Richard et al. In persons who have RA, the use of splints for purposes of rest during pain and inflammation is controversial [Egan et al. These structures are the collateral ligaments of the MCPs, the volar plates of the IPs, and the wrist capsule and ligaments. The proximal end of the trough should be flared or rolled to avoid a pressure area. Application: 1. Intrinsic plus hand is a contracture of the intrinsic hand muscles characterized by excessive flexion at the metacarpophalangeal (MCP) joints and extension at the interphalangeal (IP). Premolded Hand Splints There are a variety of hand splints that can be used to treat individuals with spinal cord injuries. failure to splint the hand in an intrinsic-plus posture following a crush injury. Many products are advertised to save time and to be effective, but few studies compare splinting materials when used by therapists with the same level of experience [Lau 1998]. Rest through immobilization reduces symptoms. The splints must be ordered for application on the right or left extremity, whereas the precut splint is universal for the right or left hand. Chapter Objectives Depending on the type of splint, they may recommend wearing it during the day, at night, or for a particular task. Resting hand splints immobilize the wrist, thumb, and metacarpophalangeal (MCP) joints to provide rest and reduce inflammation. The antideformity position is often used to place the hand in such a fashion as to maintain a tension/distraction of anatomic structures to avoid contracture and promote function. The more you exercise your hands, the higher the chances of improving mobility and overall hand function. If a child is age three or older, splinting should be considered. The phases of recovery are emergent, acute, skin grafting, and rehabilitation. The study employed second-year occupational therapy students as splintmakers and first-year occupational therapy students as their clients. The antideformity position places the wrist in 30 to 40 degrees of extension, the thumb in 40 to 45 degrees of palmar abduction, the thumb IP joint in full extension, the MCPs at 70 to 90 degrees of flexion, and the PIPs and DIPs in full extension (Figure 9-9). AliLite Splints are the only prefitted splints made of featherweight AliLite. Several splints are designed to reduce spasticity. Persons in late stages of RA who have skeletal collapse and deformity may benefit from the support of a splint during activities and at nighttime [Biese 2002, Callinan and Mathiowetz 1996]. Several diagnostic categories may warrant the provision of a resting hand splint. Intrinsic Plus Hand is a hand posture characterized by MCP flexion with PIP and DIP extension. Compliance of persons with RA in wearing resting hand splints has been estimated at approximately 50% [Feinberg 1992]. Phillips [1995] recommended that persons with acute exacerbations wear splints full-time except for short periods of gentle ROM exercise and hygiene. The wrist splint is designed to maintain the wrist in a neutral position to protect against developing deformity. Several diagnostic categories may warrant the provision of a resting hand splint. You can rate this topic again in 12 months. List the purposes of a resting hand splint (hand immobilization splint). Thank you. For persons who have hand burns, therapists do not splint in the functional position. Functional position Identify the components of a resting hand splint (hand immobilization splint). The components of a resting hand splint are the forearm trough, pan, thumb trough, and C bar. Dupuytrens contracture Splints on adults should be removed for exercise, hygiene, and appropriate functional tasks. Functional position splints were made from rigid materials making splints hard, sticky, and uncomfortable. However after trying FitMi, I could feel that slowly and steadily I am improving. Positioning to counteract the forces of edema includes placing the wrist in 15 to 20 degrees of extension, the MCP joints in 60 to 70 degrees of flexion, and the PIP and DIP joints in full extension, with the thumb positioned midway between palmar and radial abduction and with the IP joint slightly flexed [deLinde and Miles 1995]. The initial splint provision for a person with hand burns should be applied with gauze rather than straps. Diagnosis is made clinically by observing the resting posture of the hand to assess the digital cascade and the absence of the tenodesis effect. When tolerable, the resting hand splint for the person who has hand burns can be adjusted more closely to the ideal position. Diagnostic Indications Lau [1998] compared the fabrication of a resting hand splint with use of a precut splint, the QuickCast (fiberglass material) with Ezeform thermoplastic material. The study employed second-year occupational therapy students as splintmakers and first-year occupational therapy students as their clients. A resting hand splint kit typically contains strapping materials and precut thermoplastic material in the shape of a resting hand splint. There is an advantage to ordering a premolded resting hand splint made from perforated material. When the wrist is in slight extension, the carpal tunnel is openas opposed to being narrowed, with 30 degrees of extension [Melvin 1989]. A prefabricated resting hand splint in an antideformity position can be applied if a therapist cannot immediately construct a custom-made splint [deLinde and Miles 1995]. Place the forearm in the large trough. He sustained a crush injury to his hand 7 months ago and reports persistent swelling in the hand for 1-2 months after the injury. Design by Elementor, Hand Splints for Spinal Cord Injury: How to Choose the Right Fit for You, therapeutic exercises for spinal cord injury. Positioning may vary, depending on the surface of the hand that is burned. Thus, it is a ripe area for future research. The thumb may or may not be immobilized by the splint. A disadvantage is that the pattern is not customized to the person. 2005]. If the web space tightens, it inhibits cylindrical grasp and prevents the thumb from fully opposing the other digits. Splints also helps maintain the normal appearance of the hands by supporting proper positioning. The degree to which a persons compliance with a splint-wearing schedule affects the disease outcome is unknown. Charcot-Marie-Tooth disease (hereditary motor-sensory neuropathy . The edges are smooth because there are no perforations near the edges of the splint. The therapist may provide a splint for a person with arthritis who has early signs of ulnar drift by placing the hand in a comfor table neutral position with the joints in mid-position. 4List the purposes of a resting hand splint (hand immobilization splint). This extension allows the entire thumb to rest in the trough. The wrist and forearm should be positioned carefully. Biese [2002] recommended that persons wear splints at night and part-time during the day. A splint applied in the first 72 hours after a burn may not fit the person 2 hours after application because of the significant edema that usually follows a burn injury. 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