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10 Principles of Proper Fit
- 1. Maintains the arch
- 2. Proper positioning
- 3. Dual obliquity respected
- 4. Freedom of movement - based on skin creases
- 5. For dynamic splints, traction is applied at 90 degrees to the rotational access
- 6. Follow contours of the extremity
- 7. Minimize friction; round, smooth and flared edges
- 8. Adequate length for a lever arm
- 9. Trough splints extend about 1/2 around circumference
- 10. Assess splint in all forearm positions
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Education of the patient must include instruction on what 4 precautions?
- 1. Skin breakdown
- 2. Numbness
- 3. Joint stiffness
- 4. Follow-up
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Skin breakdown precautions (3)
- Wash the skin and splint regularly
- Redness, blanching and pain are all indicators of excessive pressure
- Educate family and caregivers if cognition is an issue
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Numbness precautions (3)
- Results from pressure on the nerve
- Common problem areas are the base of the 1st and 5th metacarpals (CMC joint)
- The numbness will resolve quickly if the splint is replaced quickly
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Joint stiffness precautions (2)
- Maintain mobility of all joints unless contra-indicated
- Restrictions to ROM: pain and swelling
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Follow-up precautions (3)
- Determined by the type of splint provided, pathology being treated
- What is the patient's responsibility?
- Edematous tissue must be monitored closely
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Every patient who has been provided a splint should be given specific instructions on what 6 areas?
- 1. What is the purpose of the splint
- 2. How to care for the splint
- 3. What is the wearing schedule
- 4. What precautions to take
- 5. Any exercises that may be performed to facilitate functional return
- 6. Adjunct treatments (aids; activity modification)
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5 factors that impact your choice of splinting material
- 1. The patient's needs (ie plaster vs. plastic)
- 2. The type of splint required (ie rigid vs. semi-flexible
- 3. The available of different materials and their properties
- 4. The amount of time available to make the splint
- 5. Cost of the material
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What are the 4 physical properties of splinting material?
- 1. color
- 2. texture
- 3. light penetration
- 4. radio-transparency
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What are the 7 mechanical properties of splinting material?
- 1. plasticity
- 2. resistance to surface "folding"
- 3. resistance to surface scratches
- 4. resistance to fatigue
- 5. Resistance to shock
- 6. Memory
- 7. Recycling potential
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What are the thermal properties of splinting?
- 1. specific temperature
- 2. cooling time
- 3. surface temperature
- 4. resistance to traction (ability to stretch)
- 5. shrinkage
- 6. bonding (ability to stick to itself)
- 7. conformability (drape)
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Refers to the ideal amount of heat required for a material to become moldable
specific temperature (65-80 degrees)
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Cooling time:
The amount of time the material remains moldable after heating
setting time
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Cooling time:
The amount of time required for the material to return to its original rigidity
Curing time
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What are the 3 chemical properties of splinting material?
- 1. Toxicity
- 2. Skin reaction
- 3. Reaction to acids, bases and solvents
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Other characteristics of splinting material to consider (4)
- 1. Price
- 2. Dimensions
- 3. Suppliers
- 4. Precuts
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Classification according to heat temperatures:
What is 'high temperature'?
140 Celsius or 280 Fahrenheit
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Classification according to heat temperatures:
What is 'low temperature'?
50-82 celcius or 122-180 fahrenheit
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Three categories of heat temperature
- 1. High temperature
- 2. Low temperature
- 3. No heating
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What are the 4 types of straps?
- 1. Velcro
- 2. Soft strap pile (Velfoam)
- 3. Webbing
- 4. Tensor wrapping
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6 Methods of strap attachment
- 1. Velcro hook with adhesive backing
- 2. Velcro hook attached with thermoplastic material
- 3. Rivets
- 4. Chicago screws
- 5. Glue
- 6. Duct tape
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7 Factors to consider when choosing a strap
- 1. Condition of the skin
- 2. Comfort
- 3. Edema
- 4. Maintenance of the strap
- 5. Ease of application and removal
- 6. Splinting material cost
- 7. Cost
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Resting hand splint - position of rest:
Diagnosis examples (4)
- Arthritis
- Hemiplegia
- Comatose state
- Inflammatory conditions (pathological)
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Resting hand splint - position of function
Diagnosis examples (2)
- Spinal cord injury
- Progressive neuromuscular diseases
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Resting hand splint - position of protection
Diagnosis examples (2)
- Acute hand trauma
- Burns
- Infections
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Why is perforated material better?
May breathe better
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Why is non-perforated material better?
Presence of open wounds that may be draining
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Is dorsal or volar better?
more soft tissue coverage on volar
Dorsal enhances proprioceptive stimulation of the extensor muscle groups and frees the palmar hand and forearm surfaces for tactile pressure
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What can be used to better align the digits in the presence of a deviation deformity (eg. arthritis) and also allow the digits to breathe preventing inter-digital skin maceration?
Finger separators
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What type of strap is most suitable for frail skin, bony prominence or the elderly?
Velfoam
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What type of wrap can be used in the presence of excessive post-traumatic edema?
Tensor wrap or coban
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Material:
A thermoplastic which combines features of both plaster and thermoplastics
It can be re-molded and you can add on pieces easily
It is very lightweight and cool to wear
It does not retain heat
Hexcelite
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Who made the long thumb spica?
Caitlin
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Who made the Thumb guantlet splint?
Me
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Who made the wrist cock-up splint?
Kiersti
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Acute phase splint:
Static splint - generally to rest tissues
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Rehab phase splints:
Static as you will change over time eg. as person regains ROM
Serial static splint
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Rehab phase splint:
Client can change
Static-progressive
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Rehab phase splint:
Block range in one direction but allows in another direction
Drop-out splint
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Rehab phase splint:
Has hinges, mainly done by orthotist
Articulated
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Rehab phase splint:
Force (eg. elastics)
Dynamic
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What are the components of the problem set?
- 1. Tissue status
- 2. Components of function (eg. ROM)
- 3. Scar
- 4. Pain
- 5. Function (ADLs)
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