Transcript Chap 3 splinting processes tools and techniques

Splinting Material,
Processes, Tools
and Techniques
Chapter 3
Is Splinting the answer?
Use the Clinical Reasoning
approach…
 Activity analysis approach…
 Anatomy and biomechanics…
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Purposes of splinting
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Improve position
Prevent deformity/contracture
Correct deformity/ contracture
Provide rest to a joint b relieving
stress
Maintain skeletal alignment
Improve function
Position extremity for improved
function
Continued…
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Assist weak movement
Substitute for absent
movement
transfer movement from
one joint to another
Assist muscle re-education
and exercise
improve independence in
activities of daily living
Splinting materials
Low- temperature thermoplatic (LTT)
material
 Soften in water heated btw 135 F and
180F (57º - 82º C)
 Therapist can put safely on patient’s skin
while plastic is still moldable
 HTT material warmed to >250 F, cannot
touch skin
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LTT often used to adapt devices for
improving function
 Example?
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PCL also has many applications in the hobbyist
market (sold under various tradenames, such as
"InstaMorph", "Friendly Plastic", "ShapeLock",
"PolyMorph", "Plastimake", "Plaast" etc). It
has physical properties of a very tough, nylonlike plastic that melts to a putty-like consistency
at only 60 °C. PCL's specific heat and conductivity
are low enough that it is not hard to handle at
this temperature. This makes it ideal for smallscale modeling, part fabrication, repair of plastic
objects, and rapid prototyping where heat
resistance is not needed. Though molten PCL
readily sticks to many other plastics, if the
surface is cooled, the stickiness can be minimized
while still leaving the mass pliable.
Material selection
Patient population
 Diagnoses
 Therapist preference
 Availability
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Material selection
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Decisions on the best material are based
on:
Cost
 Properties of thermoplastic material
 Familiarity with splinting materials
 Therapeutic goals
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Handling characteristics
 Material properties When
heated and softened
Performance
characteristics
 Material properties after the
material hardens and cooled
Handling Characteristics of Splinting Materials
Low Temperature Thermoplastics
Warm water for consistent and overall
coverage
 Heat gun for spot heating or dry heat
 Advantage: Can work with material
directly on skin
 Disadvantage: May melt in hot car or if
left near hot surface
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Memory
 Ability of the material to return to former
size, shape and thickness when re-heated
(ranges from 100% to little or no
memory)
 100% memory (turn clear): return to the
same thickness &size
 Advantage: easier to "start over" novice
therapists, serial splinting (spastic)
 Disadvantages: Constant molding
required during the cooling process.
 May "shrink" during cooling (Spot
heating)
 Constantly moulded throughout the
cooling process
Drapability
 Ability of material mold intimately over
contours of extremity without manual
assistance
 Degree of ease with which the material
conforms to the underlying shape
 Advantages: conforms well
 Disadvantages: Prone to fingerprints of
therapist, Poor memory, Stretches and
"grows", Requires cooperative
patient,
 Requires a light touch
Elasticity
Material’s resistance to stretch and tendency
to return to it’s original shape after stretch
 Advantages: Can tolerate a heavy touch
 Good with uncooperative patient, high
tone, when including multiple areas
 Disadvantages: Difficult to mould to
contours
Self Bonding (uncoated)
 Ability to adhere (stick) to itself when
heated
 Coated material required bonding agent
 Advantages: Can secure extra piece to
the splint, such as when attaching a
piece of hardware in dynamic splint
 Disadvantages: Difficult to take apart
if the material folds
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What is scoring?
Self-finishing edges
Edge is smooth and clean when cut
Decreases need to roll edges
 Advantages: less jagged edges, less
risk for pressure sores
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Heating time
 Working time
 shrinkage
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Performance Properties of
Splints
Conformability
Fits intimately into contoured areas
More comfortable
they distribute pressure best
No migration of splint on extremity
High drapable
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Performance Properties of
Splints
Flexibility
Able to withstand stresses repeatedly
Bends easily
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Example?
Circumferential splints
Performance Properties of
Splints
Durability
Length of time a material will last before
becoming brittle with age
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Rigidity
Strong
Does not bend easily
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Medium to large splints
To support the weight a larger joints
In small splint it is important if the splint
Is to stabilize a joint
Most LTT material cannot tolerate the repeated forces
involved in WB such as in foot orthoses
Perforation
Moisture permeability
Air exchange
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Mini
Maxi
Micro perforated
Reduce the weight of splint
Should not be stretched. Increase the holes
 Decrease strength and pressure distribution
Cutting a perforated splint
Finish
Texture of the surface,
smooth or grainy texture
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Colour
Commonly white but tan
A variety of other colours are
available in some products
 Bright colors with children
 Colored with unilateral
neglect
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Thickness
Common thickness is 1/8
inch
This will soften and hardens
faster than thicker
material
Thinner are used for
children or for small
splints and arthritis
patients
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Sticky-backed Velcro
 Bonds best when heated (dry heat)
Rounded corners prevent "catching
Padding
 Bonds best when heated (dry heat)
Changes fit of splint (smaller, tighter)
Moisture and odor absorption requires
replacement
Splint fabrication Process
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Creating a Pattern
Choosing appropriate material
Choosing the type of traction
Choosing splint design for a given
purpose
Fabrication
Step 1: Creating a Pattern
Necessary for success
 Pattern should be made
 Standard patterns
Tracing the outline of the hand (or body
part)
 Position error (flat and neutral)
 Contra-lateral hand
 Landmarks of hands
Draw splint pattern over the outline of
the hand
 Cut out the pattern
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Step 2: Fitting the Pattern to the
client
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Fit the pattern on the extremity
Adjust the size and shape by adding or
subtracting from the pattern, using scissors and
paper tame, so that the pattern conforms to the
area to be covered by the splint
Palpate through pattern material to find bony
landmarks, borders, creases and skin folds, to
provide cues to outline area
If a pattern is cut much larger than necessary
the splint will be difficult to mold. The pattern is
easier to mold if cut true to size
Step 2: Fitting the Pattern to the
client
Moistening the pattern paper
 Make a new pattern - major changes
 Form 3-1 hints for drawing and fitting a
splint pattern
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Step 3: Tracing, Heating and
cutting
After making and fitting the
pattern to the client, therapist
place on material sheet
 Trace it with a pencil, grease
pencil
 Ink may smear into the plastic
 Ink maybe removed with
clorine
 Cut with knife, or scissors
(pattern maybe cut later .. Cut
sheet into two halves
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Step 3: Tracing, Heating and
cutting
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Electric fry pan (Sause pan)
Temperature dial (160 F)
Water high (two thirds full)
or (2 inches deep)
Take out of water
Put on mesh / flat cloth
Cut pattern with long blade
strokes
Do not use the tip of the
scissor
Step 3: Tracing, Heating and cutting
After cutting the pattern from the sheet
 Position client
 Reheat the pattern
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Step 4: Position client
Seat client comfortably for
elbow and hand
 Gravity assisted.. Dorsum of
hand on towel roll, Forearm
in supination
OR: Hand in vertical position
 Stiff hand??
 Pain medications (30-60 min)
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Step 5: Molding the splint to client
Retrieve material from water
 Wipe off any excess water
 Check how hot is the material
 Fragile skin?
 Material sticking to hair?
 Cold spray? Dip in cold water
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Step 6: Making adjustments
Cut with scissor
 Dip in hot water
 Heat gun (off, cool, hot)
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Warm unevenly
Don’t use for major changes
Hot-cold line
Attachments
Step 7: Strapping
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Velcro hook and loop
With /without adhesive back
Variety of width and clors
Rounded corners of velcro?
Adhesive on scissors
Padded straps
Give extra to client
Avoid losing straps fig 3-6
Step 8: Padding
To avoid pressure areas
 Heat gun and push away from bony
prominence. (The ulnar head)
 Allow for padding space in the splint
 Gel disks
 Put putty over prominence before applying
material
 Replacement (open cell padding)
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Step 9: Edge finishing
If no self-finishing edges:
 Edges should be:
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Smooth
Rolled
Flared out
If material cut hot.. Finishing of
edges not needed
 Use heat gun or heated water in
fry pan
 Smooth finger prints with water
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Step 9: Edge finishing
Finish Splint Edges
Try these techniques to find which works best
for you.
 Heat edges and trim with scissors
 Heat edges and rub with a wet finger
 Edges may be smoothed with an electric
grinder or sander
 Dip in hot water until edges clear. Flare
edges outward.
 Hardened edges may be trimmed with a
deburring tool.
Splinting precautions
Alter splint if red areas on skin persist 20
minutes after removal of splint
 Increasing surface area of splint decreases
potential for pressure sores
 Arm toughs should be 2/3 length of
forearm
 Troughs should be ½ the circumference of
body part
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Avoid pressure over bony prominences
 A pressure point should be bubbled out or
enlarged rather than cut or padded
 Smooth, rolled or rounded edges
decrease pressure sores
 Address moisture due to perspiration,
wound drainage to avoid skin breakdown
or infection
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Give careful consideration for the following:
The needs and
expectations of the
patient
 Position
 Areas to be supported
 Distribution of support
(total contact Vs. small
areas of contact)
 Areas to be exposed
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Continued…
Exposure of sufficient tactile surface for
sensory input.
 Points and directions of forces.
 Movements which may be restricted by
the splint
 Ease of application and removal of splint.
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