In addition, persons may find it beneficial to wear splints at night for several weeks after the acute inflammation subsides [Boozer 1993]. Hand Immobilization Splints The volarly based forearm trough at the proximal portion of the splint supports the weight of the forearm. 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). Forearm troughs can be volarly or dorsally based. When splinting a joint with chronic RA, the rationale is often based on biomechanical factors. The primary goal of a wrist splint is toprevent overstretching of the wristextensor muscles and provide a stable base of support for completing tasks. 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 should closely monitor the person to make necessary adjustments to the splint. The thumb may or may not be immobilized by the splint. 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. Therapists may recommendMCP splintsto block motion in an inflamed joint to help reduce pain. The sides of the pan should be curved so that they measure approximately inch in height. Consult with your therapist to see what hand splints after spinal cord injury are most suitable for your needs and overall goals. The clients responded to a questionnaire addressing comfort, weight, and aesthetics. Several diagnostic categories may warrant the provision of a resting hand splint. The proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are free to move for functional tasks. These joint angles are ideal. Medical Therapy. While you can achieve massed practice with a written sheet of exercises, it can be tough to stick with it consistently and consistency is key to recovery. Based on the nature of the spinal cord injury, incomplete injuries can expect to make improvement of hand motion and strength. However, if the pans edges are too high the positioning strap bridges over the fingers and fails to anchor them properly. Lau [1998] compared the fabrication of a resting hand splint with use of a precut splint, the QuickCast (fiberglass material) with Ezeform thermoplastic material. 2. The resting hand splint has three purposes: to immobilize, to position in functional alignment, and to retard further deformity [Malick 1972, Ziegler 1984]. 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]. This is the lowest region where full movement and sensation remain. Massed practice like this helps stimulate and rewire the nervous system. This is most often accomplished by overnight wear of a static resting hand splint, in a neutral or intrinsic-plus position, or with an antispasticity splint, in the presence of hypertonicity. The thumb may be positioned midway between radial and palmar abduction to increase comfort. Therefore, palmar abduction of the thumb is the position of choice for the thumb CMC joint. 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]. 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. If the web space tightens, it inhibits cylindrical grasp and prevents the thumb from fully opposing the other digits. Charcot-Marie-Tooth disease (hereditary motor-sensory neuropathy . 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). Figure 9-6 Volar-based resting hand splint: (A) side view, (B) volar view. Design by Elementor, Hand Splints for Spinal Cord Injury: How to Choose the Right Fit for You, therapeutic exercises for spinal cord injury. 1. After a burn injury, the thumb web space is at risk for developing an adduction contracture [, The emergent phase is the first 48 to 72 postburn hours [deLinde and Miles 1995]. Figure 9-4 This resting hand splint is fabricated of soft materials and includes a dorsal forearm base design. 1994]. The level of injury refers to the location along the spinal cord where damage has occurred. Get instant access to our free exercise ebook for SCI survivors. This position is with fingers open and the thumb out of the palm, this is the opposite position of a fisted hand. With edema reduction, serial splinting may be necessary as ROM is gained to splint toward the ideal position. On physical exam, he is able to passively flex the proximal interphalangeal (PIP) joint when the metacarpophalangeal (MCP) joint is flexed but not when the MCP joint is extended. Individuals with an intrinsic plus hand will demonstrate difficulty gripping large objects. Typically, it is recommended that a child wear this type of splint at night to provide a prolonged stretch for 6-8 hours. deLinde and Knothe [2002] suggested that for children under the age of three therapists may not need to splint unless it is determined that the wrist requires support. The therapist should attempt to position the carpometacarpal (CMC) joint in 40 to 45 degrees of palmar abduction [Tenney and Lisak 1986] and extend the thumbs interphalangeal (IP) and metacarpal joints. Ball splints implement a reflex-inhibiting posture by positioning the wrist in neutral (or slight extension) and the fingers in extension and abduction. The therapist must know the splints components to make adjustments for a correct fit. Sign up to receive a free PDF ebook with recovery exercises for stroke, traumatic brain injury, or spinal cord injury below: Government Contract Vehicles | Terms of Service | Return Policy | Privacy Policy | My Account, Copyright 2023 All rights Reserved. The best hand splints for spinal cord injury include: A resting hand splint is themost commonlyused hand splint for spinal cord injury. These splints helpstabilize the fingerswhile allowing the tips to be used, such as for touch screen smartphones or tablets. A spinal cord injury can impair various bodily functions, including the ability to use your hands. Diagnosis is made clinically by physical examination and performing various provocative tests depending on the location of the injury. If a child is age three or older, splinting should be considered. Rest through immobilization reduces symptoms. For children with dorsal hand burns, during the emergent phase the MCP joints may not need to be flexed as far as 60 to 70 degrees. However, it may prevent further deformity. Figure 9-5 The components of a resting hand splint are the forearm trough, pan, thumb trough, and C bar. You can rate this topic again in 12 months. Fortunately, wearing proper hand splints after a spinal cord injury can help control and prevent further injury or serious deformities. ), Figure 9-4 This resting hand splint is fabricated of soft materials and includes a dorsal forearm base design. [1994] conducted an in-depth literature review to find a standard dorsal hand burn splint design. Forearm troughs can be volarly or dorsally based. A resting hand splint is a static splint that immobilizes the fingers and wrist. Determine a resting hand (hand immobilization) splint-wearing schedule for different diagnostic indications. Ball splints implement a reflex-inhibiting posture by positioning the wrist in neutral (or slight extension) and the fingers in extension and abduction. Carius BM, Canine CR, Long B. Intrinsic plus hand: Painful Finger flexion and extension . 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. 9Apply knowledge about the application of the resting hand splint (hand immobilization splint) to a case study. The therapist also has control over joint positioning. Instead, the therapist places the hand in the intrinsic-plus or antideformity position (seeFigure 9-9). Forearm troughs can be volarly or dorsally based. 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. For dorsal surface hand burns, the splint should position the hand in the angle of antideformity, also referred to as intrinsic plus position. In persons who have RA, the use of splints for purposes of rest during pain and inflammation is controversial [Egan et al. When tolerable, the resting hand splint for the person who has hand burns can be adjusted more closely to the ideal position. These off-the-shelf splints are made in a variety of shapes and sizes and are much easier and faster to use. Dorsally based forearm troughs are located on the dorsum of the forearm. According to Falconer [1991, p. 83], Theoretically, by realigning and redistributing the damaging internal and external forces acting on the joint, the splint may help to prevent deformity __or improve joint function and functional use of the extremity. Therapists who splint persons with chronic RA should be aware that prolonged use of a resting hand splint may also be harmful [Falconer 1991]. When the wrist is in slight extension, the carpal tunnel is openas opposed to being narrowed, with 30 degrees of extension [Melvin 1989]. . Short opponens splints also help facilitate tenodesis by opposing the thumb and preventing it from overstretching when performing tasks. (Preformed Anti-Spasticity Hand Splint; courtesy North Coast Medical, Inc., Morgan Hill, California.) 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]. Positioning may vary, depending on the surface of the hand that is burned. Figure 9-1 This splint is based on a resting hand splint design and is often used for individuals with rheumatoid arthritis. For dorsal and volar burns, the therapist should flex the MCPs into 70 to 90 degrees, fully extend the PIP joints and DIP joints, and palmarly abduct the thumb to the index and middle fingers with the thumb IP joint extended [Salisbury et al. Click here to get instant access. Although hand immobilization splints are commonly used, a paucity of literature exists on their efficacy. Judith Wilton, Hand Splinting: . Others are sold as precut resting hand splint kits that include the precut thermoplastic material and strapping mechanism. summary. However, if the perforated premolded or precut splint must be trimmed through the perforations a rough edge may result. According to Falconer [1991, p. 83], Theoretically, by realigning and redistributing the damaging internal and external forces acting on the joint, the splint may help to prevent deformity __or improve joint function and functional use of the extremity. Therapists who splint persons with chronic RA should be aware that prolonged use of a resting hand splint may also be harmful [Falconer 1991]. Typing on a computer can be challenging after a spinal cord injury, but typing hand splints help stabilize finger positions. However, typing splints can only be used on a regular computer keyboard. Generally, two types of positioning are accomplished by a resting hand splint: a functional (mid-joint) position and an antideformity (intrinsic-plus) position. i. Functional position ii. Therefore, the precut splint may require many adjustments to obtain a proper fit. When the wrist is in slight extension, the carpal tunnel is openas opposed to being narrowed, with 30 degrees of extension [Melvin 1989]. When a great amount of forearm support is desired, a volarly based forearm trough is the best design (Figure 9-6). Compliance of persons with RA in wearing resting hand splints has been estimated at approximately 50% [Feinberg 1992]. Thus, a wide range of designs exists for splinting dorsal hand burns [Richard et al. Diagnostic indication determines the general position used. Depending on the severity of your spinal cord injury, there may be hope for improved mobility. Because of the small sample, these results should be cautiously interpretedand further studies are warranted. The wrist and forearm should be positioned carefully. The resting hand splint maintains the hand in a functional or antideformity position, preserves a balance between extrinsic and intrinsic muscles, and provides localized rest to the tissues of the fingers, thumb, and wrist [Tenney and Lisak 1986]. According to Lau [1998, p. 47], The exact specifications of the functional position of the hand in a resting hand splint and the recommended joint positions vary. One functional position that we suggest places the wrist in 20 to 30 degrees of extension, the thumb in 45 degrees of palmar abduction, the metacarpophalangeal (MCP) joints in 35 to 45 degrees of flexion, and all proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints in slight flexion. Persons who require resting hand splints commonly have arthritis [Egan et al. Cone splints combine a hand cone and a forearm trough, which maintains the wrist in neutral, inhibits the long finger flexors, and maintains the web space (Figure 9-3). (Rolyan Burn splint; courtesy Rehabilitation Division of Smith & Nephew, Germantown, Wisconsin.) While in a complete spinal cord injury there may be no unaffected neural pathways remaining, an incomplete spinal cord injury has potential for regaining movement during rehabilitation. 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). The splintmakers also responded to a questionnaire asking about measuring fit, edges, strap application, aesthetics, safety, and ease of positioning. (Preformed Anti-Spasticity Hand Splint; courtesy North Coast Medical, Inc., Morgan Hill, California. 2001, Ouellette 1991]; postoperative Dupuytrens contracture release [Prosser and Conolly 1996]; burn injuries to the hand, tendinitis, hemiplegic hand [Pizzi et al. The therapist must know the splints components to make adjustments for a correct fit. Dorsal-based resting hand splint: (A) dorsal view, (B) volar view. Precut Splint Kits Bend-to-fit construction allows easy modification without heat or tools even at the difficult to fit thumb. Design to optimally position the hand in an intrinsic-plus position after a burn injury. With edema reduction, serial splinting may be necessary as ROM is gained to splint toward the ideal position. While many hand splints provide similar benefits, its important to determine the best fit for you. If you liked this post, youll LOVE our emails and ebook. An advantage of using a kit is the time the therapist saves by elimination of pattern making and cutting of thermoplastic material. Palmar-dorsal splints are designed to be worn regularly for extended periods of time. Phillips [1995] recommended that persons with acute exacerbations wear splints full-time except for short periods of gentle ROM exercise and hygiene. The phases of recovery are emergent, acute, skin grafting, and rehabilitation. using a kit is the time the therapist saves by elimination of pattern making and cutting of thermoplastic material. 2001]. 1List diagnoses that benefit from resting hand splints (hand immobilization splints). A 45-year-old carpenter complains of difficult gripping a hammer, which worsens with repeated use. A 39-year-old construction worker presents to your clinic with a complaint of decreased ability to use his right hand at work. Resting Hand Splints. 1990]. Resting splint the shape you've trusted and the comfort that just isn't possible with hard plastics. A resting hand splint with the hand in a functional (mid-joint) position. Antideformity position When fabricating a custom splint for a person with excessive edema, a therapist should avoid forcing wrist and hand joints into the ideal position and risking ischemia from damaged capillaries [deLinde and Miles 1995]. Static splinting is initiated during the emergent phase to support the hand and maintain the length of vulnerable structures [deLinde and Miles 1995]. deLinde and Miles [1995] suggested that prefabricated splints may be appropriate for superficial burns with edema for the first three to five days. Joints that are receptive to proper positioning may allow for optimal maintenance of range of motion (ROM) [Ziegler 1984]. When inflammation and pain are present in the hand, the joints and surrounding structures become swollen and result in improper hand alignment. Conversely, Intrinsic Plus Hand is caused due to a muscle imbalance between spastic or tight intrinsics and weak extrinsics. The sides of the pan should be curved so that they measure approximately inch in height. Thus, it is a ripe area for future research. Use clinical judgment to evaluate a fabricated resting hand splint (hand immobilization splint). AliLite Splints are the only prefitted splints made of featherweight AliLite. The resting hand splint has three purposes: to immobilize, to position in functional alignment, and to retard further deformity [Malick 1972. The advantage is an exact fit for the person, which increases the splints support and comfort. Figure 9-7 Dorsal-based resting hand splint: (A) dorsal view, (B) volar view. Application: 1. Youll also receive our popular recovery emails with SCI survivor stories and other useful tips you can opt out anytime. 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