Скачать презентацию Splinting Orthoses and Casting for Occupational Therapy Students Скачать презентацию Splinting Orthoses and Casting for Occupational Therapy Students

ed13b2d703c243a53ff61fd051adc088.ppt

  • Количество слайдов: 43

Splinting, Orthoses, and Casting for Occupational Therapy Students: OT 460 B Splinting, Orthoses, and Casting for Occupational Therapy Students: OT 460 B

Learning Objectives • At the end of this session, the learner will: – 1. Learning Objectives • At the end of this session, the learner will: – 1. Review Anatomy of the Hand Forearm – 2. Identify and Explain the four phases of prehension – 3. List and explain the purposes of splinting, casting and orthotic devices. – 4. Describe types of splints, casts, and/or orthoses and their implications for use – 5. Fabricate two splints cast with minimal supervision (after a demonstration)

Frames-of-References for Splinting • Biomechanical – Uses principles of kinetics and forces acting on Frames-of-References for Splinting • Biomechanical – Uses principles of kinetics and forces acting on the body • Sensory motor – Used to inhibit or facilitate normal motor responses • Rehabilitation – Facilitates maximal function

Definitions • Orthosis – Any medical device applied to or around a body segment Definitions • Orthosis – Any medical device applied to or around a body segment to address physical impairment or disability – Brace and support are terms used for an orthosis – A force system designed to control, correct, or compensate for a bone deformity, deforming forces, or forces absent from the body – Refers to a permanent device to replace or substitute for loss of muscle function

Definition of Splint • Device for immobilization, restraint, or support of any part of Definition of Splint • Device for immobilization, restraint, or support of any part of the body • Usually thought of as more temporary than an orthosis • American Society of Hand Therapists (ASHT) Splint classification: – Static splint – Static progressive splints – Dynamic splints

Anatomy of the forearm and hand • Bones: – 27 Bones- carpals, metacarpals and Anatomy of the forearm and hand • Bones: – 27 Bones- carpals, metacarpals and phalanges – 8 carpals arranged in two rows: • radial to ulnar in proximal row= scaphoid, lunate, triquetrum and pisiform • radial to ulnar in distal row= trapezium, trapezoid, capitate, and hamate • Wrist Flexion/Ext and RDUD occur at the radiocarpal and midcarpal joint

Anatomy of the forearm and hand • Arches: – Transverse Arch • comprised of Anatomy of the forearm and hand • Arches: – Transverse Arch • comprised of the heads of the metacarpals • it is always oblique – Longitudinal Arch • follows the long lines of the metacarpal and carpal bones alone a slightly oblique line along the third finger – Proximal Transverse Arch • comprised of the carpal bones and the annular ligament

Anatomy of the forearm and hand • Palmar skin is tight, irregular and has Anatomy of the forearm and hand • Palmar skin is tight, irregular and has several creases that create contour – Wrist crease – Thenar crease – Distal Palmar Crease – Palmar digital Crease – PIP crease – DIP crease

Anatomy of the forearm and hand • Joints of the Wrist and Hand – Anatomy of the forearm and hand • Joints of the Wrist and Hand – Radiocarpal – Carpometacarpal – Metacarpophalangeal – Proximal Interphalangeal – Distal Interphalangeal

Anatomy of the forearm and hand • Position of Rest in the wrist and Anatomy of the forearm and hand • Position of Rest in the wrist and hand: – midway between pronation and supination – wrist is 12 to 20 degrees of extension – phalanges are slightly flexed – thumb is in partial opposition and forward

Anatomy of the forearm and hand • Position of function: – wrist in 20 Anatomy of the forearm and hand • Position of function: – wrist in 20 -35 degrees of extension – normal transverse arch – thumb in abduction and opposition and lined up with pads of other fingers – PIP jts are flexed 45 to 60 degrees – Wrist must be stable to be able to use hands

Four Phases of Prehension • Reach – client must have functional range in all Four Phases of Prehension • Reach – client must have functional range in all proximal joints of forearm – client must be able to stabilize proximal arm and trunk during reach – client must have adequate strength to maintain position and accomplish as motion

Four Phases of Prehension • Prehension Patterns (Grasp, Pinch, Hook) – Pinch: • Tip Four Phases of Prehension • Prehension Patterns (Grasp, Pinch, Hook) – Pinch: • Tip Pinch • Palmar, 3 -Jaw, Tripod Pinch • Lateral Pinch

Four Phases of Prehension • Grasp – Cylindrical • palm serves as an opposition Four Phases of Prehension • Grasp – Cylindrical • palm serves as an opposition platform for flexed fingers • used to hold hand rails, tools and sports equipment • the grip of the 4 th and 5 th fingers stabilizes the grasp • need some degree of thumb abduction to get the object into the palm • typically, wrist is in extension

Four Phases of Prehension • Ball • palm acts as a platform with all Four Phases of Prehension • Ball • palm acts as a platform with all five fingers around a spherical object • wrist is stabilized in dorsiflexion (extension) • Hook • accomplished by flexion of the fingers without the use of the thumb • metacarpals and wrist joints are in neutral • Used to carry objects by a handle

Four Phases of Prehension • Carry – Gravity- acts upon us as we carry Four Phases of Prehension • Carry – Gravity- acts upon us as we carry objects – Balance- proprioception is necessary to carry objects – Inertia- is the resistance of objects to movement – Stability- of proximal joints is necessary when carrying objects – Leverage- changes during progression of an activity – Release – usually achieved by extension of digits

Purposes of Splinting, Orthotics, and Casting: • Splinting and Orthotics are used for the Purposes of Splinting, Orthotics, and Casting: • Splinting and Orthotics are used for the following purposes: – Protection- prevention of injury, or used with decreased sensation – Immobilization- used during the recovery stage of an injury – Support- used to prevent injury or joint deformities

Purposes of Splinting, Orthotics, and Casting: • Splinting and Orthotics are used for the Purposes of Splinting, Orthotics, and Casting: • Splinting and Orthotics are used for the following purposes: – Positioning- used to prevent edema, promote functional position, or prevent deformities. Can also be used to help weak muscles. – Correction- used to correct a deformity or stretch out a contracture (c-splint)

Purposes of Splinting, Orthotics, and Casting • Splinting and Orthotics are used for the Purposes of Splinting, Orthotics, and Casting • Splinting and Orthotics are used for the following purposes: – Function- may facilitate function (ulnar drift splint) or substitute for lost function (wrist drop splint) – Modify tone- spasticity splints actually fatigue muscles out until they relax

Purposes of Splinting, Orthotics, and Casting • Casting is used for the following purposes: Purposes of Splinting, Orthotics, and Casting • Casting is used for the following purposes: – Immobilization- done during the healing phase of a bone, joint, ligament, or tendonous structure – Protection, positioning and support during the healing phase – Correction -deformities can be gradually corrected through serial casting

Splint Evaluation Criteria: • • • Need Design Mechanics Construction Fit Splint Evaluation Criteria: • • • Need Design Mechanics Construction Fit

Orthotic Selection • Consider the following: – What is the clinical or functional problem? Orthotic Selection • Consider the following: – What is the clinical or functional problem? – What are the indications for and goals of splint use? – How ill orthosis affect the problem and the client’s function? – What are the benefits of the splint/orthosis? – What are the limitations of the splint/orthosis? – Should the splint be custom made or prefabricated?

Classification of Splints: • Forearm based, hand based; or finger based • Volar or Classification of Splints: • Forearm based, hand based; or finger based • Volar or Dorsal placement • Rigid (i. e. . . thermoplastic, plaster) or Soft (neoprene, velfoam, leather)

Types of static splints, orthoses and casts • Splints: – Resting Pan – Cock-up Types of static splints, orthoses and casts • Splints: – Resting Pan – Cock-up – Thumb Spica – Ulnar drift splint – C-Bar splint – Gutter splints – Boutonniere and Swan-Neck splints

Types of static splints, orthoses and casts • Orthoses: – Slings – AFO – Types of static splints, orthoses and casts • Orthoses: – Slings – AFO – BFO/ Mobile Arm Support, Deltoid Aide, Swedish Aide, – Lapboard, positioning wedge etc. . .

Types of static splints, orthoses and casts • Casts: – Immobilization casts – Serial Types of static splints, orthoses and casts • Casts: – Immobilization casts – Serial Casts – Drop-out casts

Fabrication principles • Requirements of a Well Designed Splint – Maintains arches, should contour Fabrication principles • Requirements of a Well Designed Splint – Maintains arches, should contour to the skin – Maintains axis of motion – Permits balanced function of unaffected muscles (i. e. . does not immobilize whole extremity just to splint the finger) – Allows maximal mobility while providing optimal stability

Fabrication Principles • Requirements of a Well Designed Splint – Frees palmar surface of Fabrication Principles • Requirements of a Well Designed Splint – Frees palmar surface of the hand digits for the greatest amount of sensory perception – Places minimal stretch on joints or muscles in a more prolonged period, rather than going for a quick correction – Increases surface area to distribute pressure by using padding – Follows contours of the normal hand forearm

General Precautions for Splints • Splints should be designed for individuals and systematically re-evaluated General Precautions for Splints • Splints should be designed for individuals and systematically re-evaluated for fit • Splints should be worn intermittently • Splints should be worn for as long of a duration as they are functional • Avoid tight circling around the extremities with the strapping, there should be no blanched areas where circulation is decreased

General Precautions for Splints • Avoid making the forearm too long or too short General Precautions for Splints • Avoid making the forearm too long or too short as this provides inadequate leverage (generally go 2/3 rds of the forearm) • The palmar piece should fit the metacarpal transverse arch to avoid blocking MP motion • Avoid positions of hyperextension. The IP joints of digits should be flexed about 15 -25 degrees.

General Precautions for Splints • Forearm shaft of the splint should be designed as General Precautions for Splints • Forearm shaft of the splint should be designed as a trough. The sides should come up midway on the sides of the forearm • An exercise program should be used in conjunction with splinting wherever possible

Patient Compliance • To ensure pt. compliance and efficient use of splints the splints Patient Compliance • To ensure pt. compliance and efficient use of splints the splints should be: – simple in design – as comfortable as possible – lightweight – easy to put on and take off – as cosmetically pleasing as possible – free of pressure areas – readily adjustable

Materials Overview • Materials need to be evaluated for the following properties: – stretchability Materials Overview • Materials need to be evaluated for the following properties: – stretchability – drapability – rebound – elastic memory

Materials Overview • High Temperature Materials: – Nyloplex – Royalte – Kydex • Moderate Materials Overview • High Temperature Materials: – Nyloplex – Royalte – Kydex • Moderate Temperature Materials: – High Impact vinyl

Materials Overview • Low Temperature Materials: – Orthoplast – Synergy – Ezeform – San-Splint Materials Overview • Low Temperature Materials: – Orthoplast – Synergy – Ezeform – San-Splint – Aquaplast

Materials Overview • Low Temperature Materials (continued) – Polyform – Kay-Splint – SOS-Plastazote • Materials Overview • Low Temperature Materials (continued) – Polyform – Kay-Splint – SOS-Plastazote • No-Heat or Layered Materials • Plaster of Paris • Fiberglass casting

Splinting Supplies • Equipment – Heat pan/ hydrocallator – Heat gun – Sewing machine Splinting Supplies • Equipment – Heat pan/ hydrocallator – Heat gun – Sewing machine • Tools – Scissors for material such as velcro – Sharp scissors for cutting splinting materials – Curved scissors for cutting splinting materials – Leather punch

Splinting Supplies • Tools (continued) – Wire snips – Utility Knife – Needle nosed Splinting Supplies • Tools (continued) – Wire snips – Utility Knife – Needle nosed pliers – Tongs – Wire bender

Splinting Supplies • Materials other than splinting material – Paper towels or tissue for Splinting Supplies • Materials other than splinting material – Paper towels or tissue for making patterns – Towels for drying splinting materials before application – Stockinette- to apply beneath the splint – Velcro, Velfoam, strapping materials etc. . – Lining materials, moleskin

Splinting Supplies • Materials other than splinting material – fishing line and leather for Splinting Supplies • Materials other than splinting material – fishing line and leather for outrigger splints – adhesive and solvent to clean material in prep for glueing – safety pins and rubber bands for dynamic splints – cold spray

Patient education regarding splints, orthosis, and casts • Pt. education should consist of the Patient education regarding splints, orthosis, and casts • Pt. education should consist of the following: – the purpose of the splint – the correct method of application – the need for regular review and ongoing evaluation of the client and their splint – the importance of checking the skin for pressure areas

Patient Education • Patient Education Should consist of the following: – the importance of Patient Education • Patient Education Should consist of the following: – the importance of understanding that the splint should not cause pain – that splints should be worn according to the prescribed schedule – that clients must still perform their therapy programs

Now You Do It! • Divide up into pairs: – One person makes a Now You Do It! • Divide up into pairs: – One person makes a thumb spica splint (a. k. a. Thumb palmar abduction immobilization splint or short or long opponens splint or thumb gauntlet splint) – One person makes a flexor tendon dynamic splint