splinting little hands - the royal children's hospital · splinting little hands ... •...
TRANSCRIPT
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Occupational Therapy Department
The Royal Children’s Hospital
Melbourne, 2014
Splinting Little Hands
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• Splint wearing schedules
• Splinting for hand contractures
• Assessment
• Considerations
• Splint design
• Securing splints
• Linings, skin care
• Useful materials
Presentation outline
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• Apply splint for particular activities
• In older child used as an adjunct to retraining during
therapy (such as after surgery, Botox or casting)
Splint wearing schedules
- Improving hand function
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Splint wearing schedules
- Managing contractures
To prevent contracture
• Continuous low-load stretch for several
hours
• Reversal of imbalances or hypertonic
posture
• Night splinting is appropriate
To reduce contracture
• Long periods of continuous low-load stretch – day
and night
• Regular adjustment required as length is achieved
• Serial casting is appropriate
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• Many deformities can be prevented or minimised by splinting
Timing and protocol
• As early as possible after birth
• Most successful correction before 4-6 months of age
• Rigid thermoplastic splinting (for existing contracture)
• Up to 20 hours daily; 4 hours movement*
• Frequent serial adjustment
• When resolved: 12 hours overnight to maintain
* It is important to balance the splinting regime with other developmental goals and fine motor milestones
Splinting for congenital hand
contractures
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Advantages
• More normal bone growth & joint formation
• Muscle strengthening with improved biomechanical
advantage of weak muscles
• Clarification of absence or weakness of muscles which
may require surgery
• Improved functional potential & use with developmental
progression
• Avoidance of surgery or reduction in number of
procedures
Splinting for congenital hand
contractures
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Responsive conditions include:
• Camptodactyly
• Clasp thumb
• Radial dysplasia
• Arthrogryposis
Splinting for congenital hand
contractures
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Multiple interacting components to be analysed
• Passive movement limitations
• Active patterns of movement
• Weakness
• Sensation
• Pain
• If hypertonicity present - type and degree
• Hand function and performance
Assessment
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• The pathology
• The small size
• The parents
• The child
• Infants – splinting easier when asleep or recently fed
• Babies to 3 years - splinting easier with distraction & parent involvement
• 3 years and over - splinting easier with explanation, responsibility and choices
Considerations
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• The art of compromise
• Lateral thinking
• Minimal stiffness
Splint design
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• Lightweight for small hand
• Ability of material to contour
• Memory for serial molding if needed
• Rigidity for weight bearing if needed
• Easy application for parents
• Firm contouring strapping to prevent slipping & removal
• Avoidance of perforated material where possible
• Consider if child is mouthing – do not use small splints or material that may be swallowed
Splint design
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• Velcro alternatives
• Velfoam
• Nu-Stim (conforms, non slip)
• Adhesive dressing tapes
• Bandages
• If the child removes the splint, consider a tubigrip sling covering the entire arm or hide splint under clothing
Securing splints
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• Disposable adhesive liners
• Curash if not mouthing
• Nu-Stim lining
Silicone putties including Otoform K
• can add rigidity if needed e.g. thumbs
• can improve alignment of fingers in finger pan
Saliva management
• Cover with mitten or sock if tolerated to discourage mouthing
Linings & care of skin
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Splint patterns
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• Orfit 1.6mm or 2mm
• Nu-Stim for straps or splints
• Extra-thin Velcro
Useful materials
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• Satin power lycra with Orfit insert
Useful materials
* See “How to make a neoprene gauntlet” video
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• Hypafix – low irritant, sticks well, may need adhesive
dissolver. Be aware of unidirectional stretch and use to
suit the situation:
• Scar management/web spaces
• Securing splints/over straps
• Micropore – inexpensive, easy to remove, good over
straps as a foil for little fingers
• Leukosilk tape – more expensive, but low irritant and
will re-adhere if necessary
Useful tapes
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• Ensure that babies and young
children have lots of
opportunities for play,
exploration and weight -
bearing through their hands
without their splints, unless this
is contra-indicated by their
condition or recent surgery
Splints off!
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Occupational Therapy Department
The Royal Children’s Hospital
Flemington Road
Parkville 3052
Phone (03) 9345 9300
With thanks to Tanya Cole, Rose Biggins and Josie Duncan