deLinde and Miles [1995] suggested that prefabricated splints may be appropriate for superficial burns with edema for the first three to five days. Periods of rest (three weeks or less) seem to be beneficial, but longer periods may cause loss of motion [Ouellette 1991]. 3Describe the antideformity or intrinsic-plus position of the wrist, thumb, and digits. The resting hand splint has three purposes: to immobilize, to position in functional alignment, and to retard further deformity [Malick 1972, Ziegler 1984]. The wrist splint is designed to maintain the wrist in a neutral position to protect against developing deformity. The degree to which a persons compliance with a splint-wearing schedule affects the disease outcome is unknown. Persons who require resting hand splints commonly have arthritis [Egan et al. However, it may prevent further deformity. Perforations at the edges of splints are undesirable because of the discomfort they often create. If left unmanaged, further complications can develop which decrease overall ability to return to a prior level of function. When the volar surface of the forearm must be avoided because of sutures, sores, rashes, or intravenous needles, a dorsally based forearm trough design is frequently used (Figure 9-7). The volarly based forearm trough at the proximal portion of the splint supports the weight of the forearm. 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. However, neuroplasticity is best activated with high repetition of exercises, ormassed practice. Instead, the therapist places the hand in the intrinsic-plus or antideformity position (seeFigure 9-9). Each exercise features pictures of a licensed therapist to help guide you. Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Google+ (Opens in new window) The forearm trough can be used as a lever to extend the wrist in addition to extending the fingers. They especially help individuals with wrist extensors who lack mobility in the fingers. Figure 9-7 Dorsal-based resting hand splint: (A) dorsal view, (B) volar view. The thumb may be positioned midway between radial and palmar abduction to increase comfort. Similar to premolded splints, precuts from perforated materials contain perforations in only the body of the splint. When the wrist is bent upwards (extended), the fingers curl up together and form a grip. A splint can be recommended by a physician or a rehabilitation therapist. Figure 9-9 A resting hand splint with the hand in an antideformity (intrinsic-plus) position. Typing splints are designed to help survivors use a keyboard. Rheumatoid Arthritis Some persons with burns may not initially tolerate these joint positions. Similar to premolded splints, precuts from perforated materials contain perforations in only the body of the splint. The advantage is an exact fit for the person, which increases the splints support and comfort. Kits are available according to hand size (i.e., small, medium, large, and extra large). It will be forearm based to allow for a functional position with the wrist stabilized and a slight bend of the fingers. 2. The curved sides add strength to the pan and ensure that the fingers do not slide radially or ulnarly off the sides of the pan. Resting splint the shape you've trusted and the comfort that just isn't possible with hard plastics. Ask your therapist to ensure it is safe and suitable for you. 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. Periods of rest (three weeks or less) seem to be beneficial, but longer periods may cause loss of motion [, When splinting a joint with chronic RA, the rationale is often based on biomechanical factors. However, research indicates that some persons with RA who wore their splints only at times of symptom exacerbation did not demonstrate negative outcomes in relation to ROM or deformities [Feinberg 1992]. Rest through immobilization reduces symptoms. When the volar surface of the forearm must be avoided because of sutures, sores, rashes, or intravenous needles, a dorsally based forearm trough design is frequently used (. (Rolyan Burn splint; courtesy Rehabilitation Division of Smith & Nephew, Germantown, Wisconsin. A resting hand splint is usually worn throughout the night, with wearing tolerance increasing over a few days. In addition, persons may find it beneficial to wear splints at night for several weeks after the acute inflammation subsides [Boozer 1993]. Several diagnostic categories may warrant the provision of a resting hand splint. Periods of rest (three weeks or less) seem to be beneficial, but longer periods may cause loss of motion [Ouellette 1991]. Individuals with an intrinsic plus hand will demonstrate difficulty gripping large objects. Figure 9-5 The components of a resting hand splint are the forearm trough, pan, thumb trough, and C bar. The therapist conforms the pan to the arches of the hand, thus helping to maintain such hand functions as grasping and cupping motions. Resting Hand Splint wrist at 20-30 deg ext, thumb at 45 deg palmer abd, MCPs at 35-45 deg flex, and PIPs/DIPs in slight flex; RA, Crush injuries, burns, spasticity due to upper motor neuron lesions, flaccidity Hand based finger splint for immobilizing MCP in extension with IP joint free trigger finger Cock-Up Splint Figure 9-1 This splint is based on a resting hand splint design and is often used for individuals with rheumatoid arthritis. The emergent phase is the first 48 to 72 postburn hours [deLinde and Miles 1995]. Describe the functional or mid-joint position of the wrist, thumb, and digits. Therapists often provide resting hand splints for people with rheumatoid arthritis (RA) during periods of acute inflammation and pain [Biese 2002, Ziegler 1984] and when these people do not use their hands for activities but require support and immobilization [Leonard 1990]. 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). Fingers are placed in the splint first, allowing them to gently stretch as they straighten out. A resting hand splint is a static splint that immobilizes the fingers and wrist. Figure 9-9 A resting hand splint with the hand in an antideformity (intrinsic-plus) position. Second-year occupational therapy students chosen as splint makers answered a questionnaire measuring fit, edges, strap application, aesthetics, safety, and ease of positioning. This extension allows the entire thumb to rest in the trough. Table 9-1 Key Terms 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. (Preformed Anti-Spasticity Hand Splint; courtesy North Coast Medical, Inc., Morgan Hill, California.) . RESTING HAND POSITION Prevent joint and soft tissue contractures following surgery, trauma, or injury to the hand and wrist. 2Describe the functional or mid-joint position of the wrist, thumb, and digits. Therapists should consider the resting hand splint as a legitimate intervention for appropriate conditions despite the lack of evidence. You can rate this topic again in 12 months. The splintmakers also responded to a questionnaire asking about measuring fit, edges, strap application, aesthetics, safety, and ease of positioning. Carius BM, Canine CR, Long B. Intrinsic plus hand: Painful Finger flexion and extension . For dorsal surface hand burns, the splint should position the hand in the angle of antideformity, also referred to as intrinsic plus position. 8Describe splint-cleaning techniques that address infection control. The therapist has control over joint positioning. DESCRIPTION using a kit is the time the therapist saves by elimination of pattern making and cutting of thermoplastic material. Perforations at the edges of splints are undesirable because of the discomfort they often create. Therapists must make informed decisions about whether they will fabricate or purchase a splint. 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]. The literature cited 43 splints to position the dorsally burned hand joints. Intrinsic plus hand is a contracture of the intrinsic hand muscles characterized by excessive flexion at the metacarpophalangeal (MCP) joints and extension at the interphalangeal (IP). Thus, it is a ripe area for future research. The volarly based forearm trough at the proximal portion of the splint supports the weight of the forearm. The initial splint provision for a person with hand burns should be applied with gauze rather than straps. For persons who have hand burns, therapists do not splint in the functional position. Acute Rheumatoid Arthritis 6Explain the precautions to consider when fabricating a resting hand splint (hand immobilization splint). This resting hand splint positions the hand in an antideformity position for individuals with hand burns. The " safe position " is also known as the intrinsic plus position as it favours the weaker motions of MCP flexion and IP extension that are difficult to recover. Burn resting hand splints typically position the wrist in 20 to 30 degrees of extension, the MCP joints in 60 to 80 degrees of flexion, the PIP and DIP joints in full extension, and the thumb midway between radial and palmar abduction (. 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. If youd like to learn more about FitMi, click the button below: Do you have this 15 pages PDF of SCI rehab exercises? Many products are advertised to save time and to be effective, but few studies compare splinting materials when used by therapists with the same level of experience [Lau 1998]. The thumb trough supports the thumb and should extend approximately inch beyond the end of the thumb. Therapists must make informed decisions about whether they will fabricate or purchase a splint. 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]. They are tailored to help individuals who have proper wrist extension but an imbalance between the extrinsic and intrinsic finger muscles. Therapists use clinical judgment to determine what joint angles are positions of comfort for splinting. 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. In addition, once the splint is removed there is no evidence that splint wear alters the deformity. An advantage of using a kit is the time the therapist saves by elimination of pattern making and cutting of thermoplastic material. Conversely, Intrinsic Plus Hand is caused due to a muscle imbalance between spastic or tight intrinsics and weak extrinsics. It is typically formed or fitted by a hand therapist, who is an occupational or physical therapist with specialized training in treating the upper extremity. Rest through immobilization reduces symptoms. Get instant access to our free exercise ebook for SCI survivors. The literature cited 43 splints to position the dorsally burned hand joints. List diagnoses that benefit from resting hand splints (hand immobilization splints). FitMi helps transform rehab exercises into an engaging, interactive experience. A resting hand splint kit typically contains strapping materials and precut thermoplastic material in the shape of a resting hand splint. For a person who has severe deformities or exacerbations from arthritis, the resting hand splint may also position the wrist at neutral or slight extension and 5 to 10 degrees of ulnar deviation [, Note that wrist extension varies from the typical 30 degrees of extension. Because of the small sample, these results should be cautiously interpretedand further studies are warranted. Figure 9-1 This splint is based on a resting hand splint design and is often used for individuals with rheumatoid arthritis. Other times, a ready-made splint will be used. While you can achieve massed practice with a written sheet of exercises, it can be tough to stick with it consistently and consistency is key to recovery. The sides of the pan should be curved so that they measure approximately inch in height. 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. Therapists should consider the resting hand splint as a legitimate intervention for appropriate conditions despite the lack of evidence. Although hand immobilization splints are commonly used, a paucity of literature exists on their efficacy. However, if the pans edges are too high the positioning strap bridges over the fingers and fails to anchor them properly. 1996]. If you liked this post, youll LOVE our emails and ebook. The analysis of timed trials revealed no significant difference in time required for fabricating the precut QuickCast and the Ezeform thermoplastic material. When inflammation and pain are present in the hand, the joints and surrounding structures become swollen and result in improper hand alignment. Functional splints (thermoplastic) and resting splint at night for contracture risk Copely and Kuipers 1999 Eliasson and Burtner 2009 MACS V: Does not handle objects; severely limited ability to perform [1994] conducted an in-depth literature review to find a standard dorsal hand burn splint design. List the purposes of a resting hand splint (hand immobilization splint). According to Lau [1998, p. 47], The exact specifications of the functional position of the hand in a resting hand splint and the recommended joint positions vary. One functional position that we suggest places the wrist in 20 to 30 degrees of extension, the thumb in 45 degrees of palmar abduction, the metacarpophalangeal (MCP) joints in 35 to 45 degrees of flexion, and all proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints in slight flexion. In persons who have RA, the use of splints for purposes of rest during pain and inflammation is controversial [Egan et al. 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