For example, damage to the spinal cord can result in paralysis or immobility, depending on the severity andlevel of injury. A resting hand splint kit typically contains strapping materials and precut thermoplastic material in the shape of a resting hand splint. 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. Design by Elementor, Hand Splints for Spinal Cord Injury: How to Choose the Right Fit for You, therapeutic exercises for spinal cord injury. 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]. The thumb may or may not be immobilized by the splint. Antideformity position 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. Others are sold as precut resting hand splint kits that include the precut thermoplastic material and strapping mechanism. However, if the perforated premolded or precut splint must be trimmed through the perforations a rough edge may result. Therapists fabricate custom resting hand splints or purchase them commercially. 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. 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]. The splintmakers also responded to a questionnaire asking about measuring fit, edges, strap application, aesthetics, safety, and ease of positioning. The level of injury refers to the location along the spinal cord where damage has occurred. 2005]; and tenosynovitis [Richard et al. Sometimes it is called intrinsic plus hand. 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]. To compensate for weak or paralyzed muscles of the upper body, survivors can use hand splints for spinal cord injury. Some of the commercially sold resting hand splints are prefabricated, premolded, and ready to wear.Table 9-1 outlines prefabricated splints for the wrist and hand. Table 9-1 9Apply knowledge about the application of the resting hand splint (hand immobilization splint) to a case study. Compliance of persons with RA in wearing resting hand splints has been estimated at approximately 50% [Feinberg 1992]. Note that wrist extension varies from the typical 30 degrees of extension. 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]. I feel more at ease in flexing.. Resting hand splints immobilize the wrist, thumb, and metacarpophalangeal (MCP) joints to provide rest and reduce inflammation. 2. Because of the small sample, these results should be cautiously interpretedand further studies are warranted. 2Describe the functional or mid-joint position of the wrist, thumb, and digits. Extensor Tendon Injuries are traumatic injuries to the extensor tendons that can be caused by laceration, trauma, or overuse. Kits are available according to hand size (i.e., small, medium, large, and extra large). 1990]. . When a great amount of forearm support is desired, a volarly based forearm trough is the best design (Figure 9-6). Persons who require resting hand splints commonly have arthritis [Egan et al. 1994]. A therapist can customize a resting hand splint by making a pattern and fabricating the splint from thermoplastic material. ), Figure 9-4 This resting hand splint is fabricated of soft materials and includes a dorsal forearm base design. 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. Functional Position The advantage is an exact fit for the person, which increases the splints support and comfort. The therapist has control over joint positioning. 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. However, typing splints can only be used on a regular computer keyboard. List diagnoses that benefit from resting hand splints (hand immobilization splints). These joint angles are ideal. Finger spacers may be used in the pan to provide comfort and to prevent finger slippage in the splint [Melvin 1989]. (Rolyan Arthritis Mitt splint; courtesy Rehabilitation Division of Smith & Nephew, Germantown, Wisconsin. This extension allows the entire thumb to rest in the trough. 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. CHAPTER 9 Splints can be used for joints affected by arthritis or for other conditions, such as carpal tunnel syndrome. 8Describe splint-cleaning techniques that address infection control. A resting hand splint kit typically contains strapping materials and precut thermoplastic material in the shape of a resting hand splint. The thumb web space is also vulnerable to remodeling in a shortened form in the presence of inflammation and in a situation in which tension of the structure is absent. The proximal end of the trough should be flared or rolled to avoid a pressure area. If the injury wasincomplete, it means the spinal cord was partially severed and there is still potential for the neural pathways to have partial function. Resting hand orthosis is usually fabricated in one of two positions: Functional position Anti-deformity/intrinsic-plus/safe position Functional Position of resting hand splint Wrist: 20-30 degrees extension Thumb: 45 degrees palmar abduction MP joints: 35-45 degrees flexion PIP & DIPs: slight flexion Functional position of hand Depending on the severity of your spinal cord injury, there may be hope for improved mobility. Commercially available products such as the Rolyan Aquaplast UltraThin Edging Material can be applied over the rough edges to help create a smooth-edged reinforcement on splints fabricated from Aquaplast materials [Sammons Preston Rolyan 2005]. Ball splints implement a reflex-inhibiting posture by positioning the wrist in neutral (or slight extension) and the fingers in extension and abduction. The C bar keeps the web space of the thumb positioned in palmar abduction. The thermoplastic material was rated safer than the fiberglass material. If the web space tightens, it inhibits cylindrical grasp and prevents the thumb from fully opposing the other digits. Functional position splints were made from rigid materials making splints hard, sticky, and uncomfortable. Each exercise features pictures of a licensed therapist to help guide you. 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. Based on the nature of the spinal cord injury, incomplete injuries can expect to make improvement of hand motion and strength. 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. 1. The proximal end of the trough should be flared or rolled to avoid a pressure area. It will be forearm based to allow for a functional position with the wrist stabilized and a slight bend of the fingers. A disadvantage is that the pattern is not customized to the person. With an understanding that splinting is most effective with a customized exercise program, please consult with your therapist to determine which splint option is right for you. 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). FitMi works by encouraging you to practice rehab exercises with high repetition. A disadvantage is that customization may require more of the therapists time to complete the splint and may be more costly. Some have Velcro straps which make the splints easy to put on, take off, and adjust. Hand splints are most effective when combined withtherapeutic exercises for spinal cord injury. The therapist should closely monitor the person to make necessary adjustments to the splint. The resting hand splint may retard further deformity for some persons. Home Neurological Recovery Blog Spinal Cord Injury Hand Splints for Spinal Cord Injury: How to Choose the Right Fit for You. A resting hand splint is a static splint that immobilizes the fingers and wrist. Medical Therapy. Studies on animals indicate that immobilization leads to decreased bone mass and strength, degeneration of cartilage, increase in joint capsule adhesions, weakness in tendon and ligament strength, and muscle atrophy [Falconer 1991]. Generally, two types of positioning are accomplished by a resting hand splint: a functional (mid-joint) position and an antideformity (intrinsic-plus) position. Diagnosis is made by clinical exam which shows MCP flexion and IP joint extension. Some of the commercially sold resting hand splints are prefabricated, premolded, and ready to wear. Anti-deformity (POSI) position i. Functional Position 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. With edema reduction, serial splinting may be necessary as ROM is gained to splint toward the ideal position. A 39-year-old construction worker presents to your clinic with a complaint of decreased ability to use his right hand at work. 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. Figure 9-8 A resting hand splint with the hand in a functional (mid-joint) position. It provides support to the fingers, hand, and wrist. 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 degree to which a persons compliance with a splint-wearing schedule affects the disease outcome is unknown. 1994]. The analysis of timed trials revealed no significant difference in time required for fabricating the precut QuickCast and the Ezeform thermoplastic material. Kits are available according to hand size (i.e., small, medium, large, and extra large). The pan should be wide enough to house the width of the index, middle, ring, and little fingers when they are in a slightly abducted position. A spinal cord injury can impair various bodily functions, including the ability to use your hands. These joint angles are ideal. If left unmanaged, further complications can develop which decrease overall ability to return to a prior level of function. Another disadvantage is that the commercial splint may not exactly fit each person. The C bar keeps the web space of the thumb positioned in palmar abduction. [ 15] Early recognition is essential. 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