Splinting – Flashcard
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Thermoplastic Splinting Materials
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Most commonly used to fabricate splints; considered low temperature because they soften in water heated between 135 - 180 degrees F; therapist can usually place against skin while plastic is still moldable
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Thermoplastic Splinting Materials: Elastic
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*Have some amount of memory *Coating to prevent the material from adhering to itself *Longer working time
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Thermoplastic Splinting Materials: Plastic
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*Drapable & have low resistance to stretch *Often used; highly conforming *Require skill in handling
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Thermoplastic Splinting Materials: Rubbery/Rubberlike
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*More resistant to stretching and fingerprinting *Less conforming
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Handling Characteristics: Memory
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*Describes a materials ability to return to its preheated shape, size, and thickness when reheated *100% of this will return to their original size & thickness when reheated *Most with high this turn translucent during heating; can be used as indicator of proper heating *Allows therapists to reheat & reshape splints several times; must be constantly molded to sustain maximal conformability *Good for novices *May pose problems with fine adjustments
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Handling Characteristics
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Thermoplastic materials properties when heated and softened *Memory *Drapability *Elasticity *Bonding *Self-Finishing Edges
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Performance Characteristics
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Thermoplastic materials properties after the material has cooled & hardened *Conformability *Flexibility *Durability *Rigidity *Perforations *Finish *Colors *Thickness
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Handling Characteristics: Drapability
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*The degree of ease with which a material conforms to the underlying shape without manual assistance *Duration of heating is important *The longer the material heats, the softer it becomes & the more vulnerable it becomes to gravity & stretch *Must be handled with care after heating *Best positioned on a clean countertop during cutting *Difficult to use for large splints & most successful on cooperative person who can place body part in gravity assisted position *May pose problems for novices
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Handling Characteristics: Elasticity
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*Materials resistance to stretch *Tendency to return to its original shape after stretch *Can be worked aggressively *Helpful when working with uncooperative persons, those with high tone, or when one splint includes multiple areas (forearm/wrist) **Materials with little elasticity will stretch easily and become thin; therefore, light touch must be used
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Handling Characteristics: Bonding
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*The degree to which material will stick to itself when properly heated *Some are coated, others are not *Those with coating always require surface prep with a bonding agent or solvent *Self-bonding (uncoated) may not require surface prep, but some thermoplastic materials have a coating that must be removed for bonding to occur *Coated materials tack at the edges because the coating covers only the surface and not the edges *All thermoplastics whether coated or uncoated, forms stronger bonds if surfaces are prepared with a solvent or bonding agent (which removes the coating from the material)
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Handling Characteristics: Self-Finishing Edges
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Allows any cut edge to seal and leave a smooth rounded surface if the material is cut when warm; saves time because don't have to manually roll or smooth edges
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Handling Characteristics: Other Considerations
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*Heating time: should be monitored closely; prevents material from getting excessively soft & stretchy; should be cognizant of temp material holds before applying to skin *Working time: material that is 1/8 thick is usually pliable for 3-5m; some will allow for 4-6m; materials that are thinner than 1/8 or perforated cool more quickly *Shrinkage: especially important consideration with circumferential design; precautions to prevent difficulty removing a thumb or finger from a circumferential component of a splint
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Performance Characteristics: Conformability
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*The ability of thermoplastic material to fit intimately into contoured areas *Splints that are intimately conformed are more comfortable because they distribute pressure & reduce the likelihood of the splint migrating
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Performance Characteristics: Flexibility
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*Can take stresses repeatedly *Important for circumferential splints because they must be pulled open for application & removal
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Performance Characteristics: Durability
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*The length of time splint material will last; rubberbased materials are more likely to become brittle with age
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Performance Characteristics: Rigidity
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*Strong & resistant to repeated stress *Especially important with medium > large splints (elbows/forearms); require rigid material to support more weight *In smaller splints, rigidity is important if splint must stabilize a joint *Can be enhanced by contouring
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Performance Characteristics: Perforations
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*Will allow for air exchange to underlying skin *Designed to reduce weight *Precautions: should not be stretched because stretching will enlarge the holes & decrease strength/pressure distribution; cut between perforations to prevent uneven or sharp edges
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Performance Characteristics: Finish
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*Texture of the end product *Smooth/grainy
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Performance Characteristics: Colors
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*May affect acceptance & satisfaction *Darker colors soil less *May be used to help a person with neglect attend to one side of body *Easily seen; helps prevent loss
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Performance Characteristics: Thickness
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*Common is 1/8 inch *Some available in 1/16, 3/32, 3/16 *Thinner are commonly used for arthritic patients and pediatrics *3/16 commonly used for LE splints and fx braces *Plastics thinner than 1/8 will soften and harden more quickly *Novices may find it easier to splint with 1/8 inch than thinner
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Aquaplast T
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Memory Moderate Drapability
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Ezeform
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Rigidity Conformability/Drapability Moderate Drapability Resistance to Stretch Self-Adherence
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Polyform
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Rigidity Conformability/Drapability
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Polyform Light
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Conformability/Drapability
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Polyflex II
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Conformability/Drapability
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Ezeform Light
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Moderate Drapability
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Synergy
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Resistance to Drape Resistance to Stretch Self-Adherence
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Splinting: Patterns
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*A good pattern is necessary for success *Should be made individually *If person's hand cannot be flattened for pattern; contralateral hand should be used *If contralateral hand cannot be used, the therapist may hold the paper in a manner so as to contour to the hand position
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Splinting: Fitting the Pattern
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*Moistening the paper & applying to the person's hand helps the therapist determine which adjustments are required *Patterns from aluminum foil work well to contour the pattern to the extremity *Sometimes it is easier to make new pattern if too many adjustments are necessary
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Splinting: Tracing, Heating, & Cutting
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*Use an awl to scratch pattern *Heating temps 135-180 degrees F *If heating in hydrocollator, problems may occur with vertical stretch from gravity *Cut with round or flat edges scissors
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Splinting: Reheating
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*After pattern is cut, must be reheated for molding
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Splinting: Positioning Client
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*Should be comfortable, especially for the shoulder & elbow *May use gravity assisted position for hand splinting by having the person rest the dorsal wrist area on a towel roll while the forearm is in supination to maintain proper wrist positioning *May ask the person to rest the elbow on a table and splint the hand while it is in a vertical position *For those with stiffness, modalities may be used prior to splinting
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Splinting: Molding
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*Rinse off *Check temperature *For those with sensitive skin, stockinette prior to application of splinting material *To speed up cooling process, therapist may use cold spray or cold water
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Splinting: Adjustments
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*Amount of adjustments possible depends upon the property of the material & cooling time that has elapsed *Heat gun may be used
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Splinting: Strapping
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*Rounded corners decrease the chances of corners peeling off *Strap placement is critical to a proper fit *Wrist strap placement should be at the wrist, not proximal to the wrist
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Splinting: Padding & Pressure
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*Can adjust with heat gun *Padding should not be added as an afterthought *Space must be allowed for padding
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Splinting: Edge Finishing
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*Should be smooth & rolled or flared to prevent pressure
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Splinting: Reinforcement
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*The strength of a splint increases when the plastic is curved
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Prefabricated Splints: Advantages
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*May save time & effort (if the splint fits well) *Immediate feedback from client in terms of satisfaction & therapeutic fit *Variety of material choices *Some clients prefer sports-brace appearance
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Prefabricated Splints: Disadvantages
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*Unique fit is often compromised *Little control over therapeutic positioning of joints *Expensive to stock a variety of sizes & designs *Prefabricated and soft splints usually made for a few target populations (cannot address all conditions requiring unique or creative splint design)
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Splinting: Selecting A Splint
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*Diagnosis *Age *Medical Complications *Goals *Splint Design *Occupational Performance *Person's or Caregiver's Ability to Comply with Instructions *Independence with Splint Regimen *Comfort *Environment
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Splinting: Precautions
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*Latex Sensitivity *Allergic Contact Dermatitis
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Arches of the Hand
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To have a strong functional grasp, the hand uses the following three arches: 1. Longitudinal 2. Distal transverse 3. Proximal transverse
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Proximal Transverse Arch
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*Fixed & consists of the distal row of carpal bones *Rigid & acts as a stable pivot point for the wrist & long-finger flexor muscles *Transverse carpal ligament & the bones of the proximal transverse arch form the carpal tunnel
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Distal Transverse Arch
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*Deepens with flexion of the fingers *Mobile & passes thru the metacarpal heads
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Longitudinal Arch
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*Allows DIP, PIP, & MCP joints to flex *Follows the longitudinal axes of each finger *Because of the mobility of their base, the 1st, 4th, & 5th metacarpals move in relationship to the shape & size of an object placed in the palm *Grasp is the result of holding an object against the rigid portion of the hand provided by the second & third digits
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Creases of the Hand
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*Critical landmarks for splint pattern making & molding
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Distal Palmar Crease
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*Extends transversely to a point midway between the third & second MCP joints *Landmark for the distal edge of the palmar portion of a splint intended to immobilize the wrist while allowing motion of the MCP's
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Thenar Crease
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*Begins at the proximal palmar crease & curves around the base of the thenar eminence *Should define the limit of the splint's edge; if the splint extends beyond the thenar crease toward the thumb, thumb opposition & palmar abduction of the CMC joint is inhibited
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Distal Wrist Crease
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*Extends from the pisiform bone to the tubercle of the trapezium *Forms a line that separates the proximal and distal rows of the carpal bones *Assists in locating the axis of the wrist motion *Volar surface
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Proximal Wrist Crease
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*Corresponds to the radiocarpal joint and delineates the proximal border of the carpal bones, which articulates with the distal radius *Assists in locating the axis of wrist motion *Volar surface
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Digital Palmar Flexion Creases
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*Digits II thru V *Distal digital = DIP; marks the DIP joint axis *Middle digital = PIP; marks the PIP joint axis *Proximal digital = MCP; is distal to the MCP joint axis at the base of the proximal phalanx *** Creases are close to, but not always directly over bony joints
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Prehension
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Lateral Prehension: holding a key Cylindrical: holding a cup Spherical: holding a baseball Hook: holding a suitcase handle Intrinsic Plus: holding a CD case (all 4 fingers plus thumb opposition)
