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2013-03-03 15:18:54

Show Answers:

  1. What are the 3 rules to remember when splinting?
    • 1. you control the material, the material does not control you.
    • 2. Splinting does not require brute force
    • 3. When in doubt, begin again.
  2. What are the 3 main goals of splinting?
    • 1. Prevent dysfunction
    • 2. Maintain function
    • 3. Restore function
  3. How do splints prevent dysfunction?
    • 1. Prevent weak muscles
    • -Prevent contractures
    • -Prevent stretching of unopposed muscles limiting functional recovery
    • 2. Protect newly repaired structures
    • -Conservative management of injuries
    • -Post-operative management
  4. How do splints maintain function?
    Support a joint, hand area or an arch in the presence of weak muscle
  5. How do splints restore function?
    • 1. Force a joint into a corrective position
    • 2. Provided a base against which pressure can be applied (ie. opponens splint)
    • 3. Relieve pain and discomfort (eg. plantar fasciitis, CTS)
  6. What are static splints?
    • No moveable parts
    • Whenever possible the joints should be positioned in a 'functional' position
  7. What is the "functional position"?
    • wrist 20-30 degrees extension
    • MCPs 45-50 degrees flexion
    • IPs 45 degrees flexion
    • Thumb palmar abduction, full opposition
  8. What are dynamic splints?
    Apples a force to a moveable part ("active splinting")
  9. What are the 4 things splints should do/be?
    • 1. Fulfill the physiological needs of the patient
    • -rest to the wound
    • -prevent reoccurence of contractures
    • 2. Be created as simply as possible
    • 3. Not create dysfunction
    • 4. Be cosmetically acceptable
  10. Why are OTs suited to make splints?
    • Form follows function
    • Client-centred
    • Client independence
  11. Splinting of the hand requires consideration of the 4 phases of hand function. What are they?
    • 1. Reach - requires good proximal stability
    • 2. Prehension patterns - pinch, lateral, tripod, tip to tip grasp (cyclindrical, ball and hook graps)
    • 3. Carry - requires "fair plus" muscle grade (flexors at least grade 4)
    • 4. Release (extensors)
  12. What must an OT do/know to recognize the need and be able to provide the most appropriate splint and treatment program? (10)
    • 1. Understand the normal mechanics of the hand.
    • 2. Have a good understanding of the pathology of the patient being treated.
    • 3. Conduct a thorough evaluation of the body part to be splinted. 
    • 4. Understand the function of the splint being requested.
    • 5. Understand the mechanics of splinting
    • 6. Know the design and construction of splints
    • 7. Understand the properties of various splinting materials.
    • 8. Re-evaluate - does the splint meet all the criteria?
    • 9. Provide clear instructions to patient, family and nursing staff on care, use and precautions
    • 10. Document
  13. Architecture of the hand:
    The hand is divided into which units?
    • 1. Fixed or stabilizing unit
    • 2. Mobile units
  14. Architecture of the hand:
    What are the fixed or stabilizing units of the hand?
    • The carpal bones
    • The 2nd and 3rd metacarpals
  15. Architecture of the hand:
    What are the mobile units of the hand?
    • The 4th and 5th metacarpals 
    • The 1st metacarpal (thumb) 
    • The phalanges
  16. they serve as stabilizers when an object is grasped between the thumb and index and accommodate to different shapes
    The 4th and 5th metacarpals
  17. Provides a large amplitude of movement via the trapezio-metacarpal joint in order to allow opposition
    The 1st metacarpal (thumb)
  18. Which arch?
    Is comprised of the carpal bones, metacarpals and phalanges. 
    It follows the outline of the 3rd digit and can vary in shape when the hand is used in grasping.
    Longitudinal arch
  19. Which arch?
    Consists of the carpal bones, the transverse carpal ligament and the inter-carpal ligaments. 
    This arch is concave on the palmar surface and provides the mechanical advantage to the tendons of the finger flexors by providing a fulcrum.
    The proximal transverse arch
  20. Which arch?
    Is formed by the heads of the 2nd to 5th metacarpals.
    At rest, it shows gentle obliquity (not flat), increases in depth when the hand grasps because of the mobility of the 4th and 5th metacarpals.
    The distal palmar arch
  21. These correspond to the anatomical locations of the joints
    Skin creases
  22. The _____ _______ and _________ ______ should be free to allow thumb and IP joint movement respectively.
    • Thenar eminence
    • Mid-digital crease
  23. Where do splints that allow MCP flexion end?
    Proximal to the distal palmar crease
  24. What is meant by 'dual obliquity'?
    • Metacarpals progressively decrease in length from radial to ulnar border of the hand
    • In the transverse plane, the radial metacarpals are high and there is a decline with each successive metacarpal
  25. Why are splints incorporating the 2nd to 5th metacarpals longer and higher on the radial side?
    Dual obliquity
  26. Hand positioning:
    What is the position of rest?
    • The joints are under no stress; ligaments are lax
    • Forearm: midway between pronation and supination
    • Wrist: 10 to 20 degrees extension
    • Digits: MCPs and IPs 15 to 20 degrees flexion
    • Thumb: partial opposition and forward
  27. Hand positioning:
    What is the position of function?
    • If no AROM was to be gained the hand could function under a tenodesis action
    • Forearm: Midway between pronation and supination
    • Wrist: 20 to 30 degrees extension
    • Digits: PIPs flexed to 45 degrees
    • Thumb: abduction and opposition
  28. Hand positioning:
    What is the position of protection?
    • The ligaments are immobilized under ligamentous tension in anticipation of full return of hand function.
    • Forearm: Midway between pronation and supination
    • Wrist: 30 to 40 degrees extension
    • Digits: IPs 0 degrees flexion, MCPs 90 degrees flexion
    • Thumb: Palmar abduction and opposition to D2/D3
  29. Materials:
    Most strength (3)
    • Aquaplast 3.2 mm
    • Orfit/Redifit 1.6 mm
    • Polyflex II
  30. Materials:
    Most controlled stretch (2)
    • Ezeform
    • Sansplint
  31. Materials:
    Most drapability (2)
    • Aquaplast 1.6 mm
    • Aquaplast 2.3 mm
  32. Materials:
    Most conformability/moldability (3)
    • Polyflex II
    • Aquaplast 1.6 mm
    • Aquaplast 3.2 mm
  33. Materials:
    Most self-bonding (1)
    Orfit/Redifit 1.6 mm
  34. Materials:
    Most memory (3)
    • Oftit/Redifit 1.6mm
    • Aquaplast 1.6 mm
    • Aquaplast 3.2mm
  35. Materials:
    Least resistant to finger prints
    Polyflex II