Aila Nica J. Bandong, PTRP
University of the Philippines Manila
College of Allied Medical Professions
PT 150: Orthotics and Prosthetics
At the end of the session the students should be able to:
 determine the classification used for upper extremity
orthoses
 determine diagnostic indications for upper extremity
orthoses
 determine the components and functions of upper
extremity orthoses
 discuss several static splints
 describe dynamic splints
 enumerate the purposes for prescribing dynamic
splints
 determine physiologic considerations in dynamic
splints
 determine the basic components and functions of
dynamic splints
 discuss several dynamic splints
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Orthotist
Physician
Social worker
Psychologist
Patient
Physical Therapist
Occupational Therapist
Occupational Therapy
 Hand Rehabilitation
 Maximize residual function of the patient
who has had surgery to, or an injury or the
disease of the upper extremity
Physical Therapy
 RA 5680 Section 16
 Assess the need to use assistive device and
train patients as called for
 Train patients to become functionally
independent
HANDLING
PERFORMANCE
Memory
Heating
time
Working
time
Drapability
Selffinishing
edges
Shrinkage
Elasticity
Bonding
Conformability
Finish
Colors
Flexibility
Moisture
Permeability
and Air
Exchange
Thickness
Durability
Rigidity
Type
• Static
• Dynamic
Function
• Flexion
• Extension
• Abduction
• Adduction
• Rotation
Region
• Volar or Dorsal
• Joints crossed
* Finger / thumb splint
* Wrist Splint
* Wrist Hand Orthosis
(WHO )
* Elbow (WHO)
* Shoulder (Elbow- WHO)
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Immobilize or
support
Help prevent
deformity
Prevent soft-tissue
contracture
Allow attachment of
assistive devices
Block a segment
C-Bar
Connector bar
Crossbar
 Cuff or strap
 Deviation bar
and pan
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Forearm trough
Anatomic bars
Thumb post
 Thumb trough
 Blocks
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Hypothenar Bar
Lumbrical Bar
Metacarpal Bar
Opponens Bar
Lumbrical Bar
Deviation
Bar
Metacarpal bar
Forearm trough Metacarpal bar
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Finger and thumb Orthosis
 DIP
 PIP
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Hand Orthosis
 Volar or dorsal hand orthosis
 Universal Cuff
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WHO
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Cock - up splint
Resting hand splint
Thumb spica
Antispasticity splints
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Fractures
Tendon injuries
Crush injuries
Amputation
Arthritis
Carpal tunnel
release
Arthroplasty
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Tendon transfer
Tumor excision
Reconstruction of
congenital defects
Overuse
syndromes
Cumulative trauma
disorders
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Prevent or decrease edema
Assist in tissue healing
Relieve pain
Allow relaxation
Prevent, misuse, disuse and overuse of
muscles
Avoid joint jamming or injury
Redevelop motor & sensory function
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Type
 Static or dynamic
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Region
 Volar or dorsal
 Joint crossed
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Function
Static Volar
DIP Extension Splint
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Static Three point
orthosis for
boutonniere
deformity
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Type
Region
Function
Static Dorsal
Hand Orthosis
With an MP
Block
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Universal Cuff
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Maintain the wrist in the neutral or mildly
extended position
Immmobilizes the wrist while allowing full
MCP flexion and thumb mobility
Contraindications:
 Active MCP synovitis
 Joint inflammation resulting to volar
subluxation and ulnar deviation
Disadvantages:
 Interferes with tactile sensibility on the
palmar surface of the hand
 Dorsal strap can impede lymphatic flow
Stronger mechanical
support of wrist and
freeing up some of
the palmar surface
for sensory input
 Distributes pressure
over the larger dorsal
wrist surface area
 Better tolerated by
edematous hand
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Hand Condition/
Suggested Wearing Schedule
Position
NERVE COMPRESSION
Acute flare up stage: 4 to 6 weeks
Volar, dorsal, or ulnar gutter splint
Carpal Tunnel Syndrome
continuously worn except for
with the wrist in a neutral position
(median nerve compression) cleaning/hygiene and ROM
exercises
Gradually decreases in duration with
some doctors recommending
nighttime wear only
Carpal Tunnel Release
Surgery
1 week post-surgery, fitting may
commence
Wearing schedule that applies
during sleep. Strenuous activities,
and for support throughout the
healing phase
Volar splint with the wrist in a
neutral or slightly extended position
Radial Nerve Palsy
Wrist kept in functional position and Volar or dorsal with wrist in 0 to 30
the splint should substitute for the degrees in extension
loss of the radial nerve by placing
the wrist in extension
Wrist extensor tendinitis
Continuous wearing followed by
gradual weaning of the splint
Volar with 20-30 degrees of wrist
extension
Hand Condition
FRACTURES
Colle’s fracture
(closed reduction)
Suggested Wearing Schedule
Position
Indicated following removal of the Volar with maximum passive
cast and healing of fracture
extension that the patient can
Discontinue use as soon as possible tolerate- usually up to 30 degrees
to allow functional hand movement
RHEUMATOID ARTHRITIS Worn continuously with established Volar, in extension up to 30 degrees
Periods of swelling and joint periods for ROM exercises between based on patient tolerance
inflammation
splint wearing schedule
OTHER
Reflex Sympathetic
Dystrophy
Nighttime wearing
Volar, in extension as tolerated by
patient
Wrist joint synovitis or
tenosynovitis
Worn during acute flare ups
Volar, o to 15 degrees in extension
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Immobilize to reduce symptom
Position in functional alignment
Retard further deformity
C-bar
Pan
Thumb through
Forearm through
Hand Condition
Suggested Wearing Schedule
Position
RHEUMATOID ARTHRITIS Fitted to maintain as close to a
Acute Exacerbation
functional (midpoint) position as
possible until exacerbation is over
Removed for hygiene and exercise
purposes
Worn during the day and at
nighttime as needed
WRIST: neutral or 20-30 degrees
extension depending on patient
tolerance
MCP: 15-20 degrees flexion and 510 degrees ulnar deviation
THUMB: position of comfort in
between radial and palmar
abduction
TRAUMA
Crush injuries of the hand
Fitted after the injury to reduce
pain, edema, and swelling and to
provide rest to injured tissues
Worn at nighttime and worn as
needed
WRIST: extension of 0 to 30
degrees
MCP: 60-80 degrees of flexion
PIPs and DIPs: full extension
THUMB: palmar abduction and
extension
BURNS
Dorsal or Volar hand burns
Worn after the burn injury until
healing begins and removed for
dressing changes, hygiene, and
exercise
WRIST: Volar or circumferential
burn 30-40 degrees of extension;
Dorsal burn neutral position
MCP: 70-90 degrees of flexion
DIPs: full extension
THUMB: palmar abduction and
extension
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For burns: make adjustments as bandage
bulk changes
Preventing infection: when open wound
has exudates, clean splints with warm
soapy water, hydrogen peroxide, or
rubbing alcohol
Patients in the ICU: use sterile materials;
follow protocol of the facility
RA patients benefit from thin thermoplast
( less than 1/8 inch )
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Help stabilize CMC, MCP and IP joints
Thumb
Post
Opponens
Bar
•Volar
•Dorsal
•Radial
Gutter
Hand Condition
Suggested Wearing
Schedule
Position
SOFT TISSUE
INFLAMMATION
de Quervain’s
tenosynovitis
Acute flare-up: worn
continuously with removal for
hygiene and exercise
IP joint included only if pain is
present with IP flexion and
resisted IP extension
Long Forearm-based or Radial ulnar gutter
splint:
WRIST: 15 degrees of extension
THUMB CMC: palmar abduction 40-45degrees
THUMB MCP: 5 to 10 degrees of flexion
If with inflamed tendons, the the thumb CMC
joint is sometimes positioned in radial abduction
and extension instead of palmar abduction
RHEUMATOID
ARTHRITIS
Periods of pain and
inflammation in the
thumb joint
Worn continuously with
removal for hygiene and
exercise
Wearing schedule is adjusted
according to the patient’s pain
and inflammation levels
Long Forearm-based thumb spica splint
WRIST: 20-30 degrees of extension
THUMB CMC: palmar abduction 45 degrees; or
midway between radial and palmar abduction
depending on patient’s tolerance
THUMB MCP: if included, 5 degrees of flexion
TRAUMATIC
INJURIES OF THE
THUMB
Gamekeeper’s
thumb
Worn continuously for 3 to 4
Short opponens splint
weeks with removal for hygiene MCP: joint immobilized and the thumb CMC
joint palmarly abducted 25 to 30 degrees
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A review of studies conducted by
Oldfield and Felson (2008) regarding
the effects of wrist orthotic device use
on pain and functionality in patients
with RA reveal that the splints
improved wrist pain and functionality
without compromising dexterity
Platform design
 Volar based platform
 Dorsal based platform
Finger and thumb position
 Finger spreader
 Cones
Static
Dorsal
Elbow
Orthosis
Balanced
Forearm
Orthosis
Forearm trough
Elbow dial
Distal arm
Proximal
bearing
Rocker Assembly
Distal bearing
Bracket
Shoulder slings
Humeral Fracture Brace
Airplane Splints
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To substitute for loss
of motor function
To correct an existing
deformity
Provide controlled
directional movement
Aid in fracture
alignment and wound
healing
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Too great stretch
 Fatigued
 injury
 Failure
• Enough stretch
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Too little stretch
 Atrophy and weaken
 Skin, tendons,
ligaments, and joint
capsules will shorten in
the absence of habitual
tensile forces
– Three degrees of gain in ROM per week, with a range
of 1-10 deg, is acceptable (Cummings et al 1992 )
– High intensity short term stretching actually promotes
stiffness
– The client should sense tension in the tissues but feel
no pain
Hepburn, 1987
 The stretch should not be perceived as a
“stretching” force until at least 1 hour has
passed
 Client should remain comfortable with the
orthosis for up to 12 hours
 After removal, the client should feel no
more than a stiffness or mild ache
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Outrigger
Dynamic Assist
Finger cuff
Reinforcement bar
Fingernail attachments
Phalangeal bar/finger pan
Springwire finger coils
Springwire knuckle bender
Elastic bands
Finger
hooks
Contoured finger hooks
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Dynamic finger extension splint
Dynamic wrist extension splint
Tenodesis training
Dynamic ulnar nerve splint
Capener
Anti-microstomial splint
Dynamic radial nerve splint
Objectives:
 Immobilize the wrist in
functional position
 Passively extend the MCP to 0
 Permit full active MCP flexion
and unrestricted IP motion
 Indications:
 Paralysis of wrist, MCP, Finger
extensors
 Advantages:
 Relatively has a less obtrusive
shape as compared to the
outrigger design
 The hand can be slipped
through a loose sleeve with the
orthosis on
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Finger Cuff
Dynamic Springwire Assist
Dorsal Forearm Trough
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Objectives:
 Passively extends
the wrist while
allowing wrist flexion
 To prevent
contracture of
unopposed,
innervated wrist
flexors
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Indication:
 Weak or paralyzed
wrist extensors
Metatarsal Bar
Dynamic Springwire
Knucklebender Assist
Volar Forearm Trough
Rehabilitation
Institute of Chicago
 Objectives:
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 To train tenodesis
grasp
 To promote a strong
tripod pinch with wrist
extension
 Allows finger opening
with wrist flexion
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Indication:
 C6 quadriplegia with
grade 3 strength of
wrist extensors
Finger Cuff
Thumb Spica
Dynamic Elastic
Band Assist
Forearm Cuff
Dynamic anti-claw
deformity splint, Wynn
Perry Splint
 Objectives
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 To passively flex the 4th
and 5th MCP’s
 To prevent shortening of
the MCP Collateral
ligaments
 To promote active IP
flexion
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Indication
 Ulnar nerve lesion
Metacarpal Bar
Lumbrical Bar
Dynamic
Springwire
Knucklebender
Assist
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Dynamic spring wire
splint for PIP extension
Objectives:
 To passively extend
the PIP
 Allows active IP flexion
 Provide stability to PIP
 Promote restabilization
of lateral bands and
prevent rupture of the
central slip
Advantage
 “no, profile” minimizing
its visual presence
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Indications
- PIP flexion contracture
- PIP dorsal dislocation
- Volar plate injury
- Flexor tendon repair
with resulting PIP flexion
contracture
- Partial or complete tear
of the collateral ligament
- Boutonniere deformity
Thermoplast
Dynamic
Springwire Finger
Coil Assist
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Objectives:
 To apply stretch to
tissues surrounding the
oral cavity while
permitting speech
 To prevent contractures
of lip and buccal tissues
that may lead to
limitation in oral opening
Indications:
 Facial and perioral burns
Wearing regimen
 Continuously worn
 Taken off only for
cleaning
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Precaution
 The commisures(corners)
of the lips are prone to
skin breakdown with
improper fit and tension of
the splint
Be aware of and make adjustments
for pressure areas
 Check for presence of edema
 Timing
 Compliance
 Skin reactions
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ANY QUESTIONS?