Static Splinting ~ Part IAlice Ocean COTA, Nancy Grossenbacher OTR CHT and Julie Teal OTR CHT
How Custom Fabricated Splints Can Help Your Practice
Fabricated splints/orthotics* may be static, dynamic or static progressive. Static orthotics are often used to put part or all of the elbow, wrist & hand at rest so that diseased or injured tissue can be supported and undergo uninterrupted healing. Dynamic or static progressive orthotics are used to add mobilizing tension to influence tissue healing and scar maturation, minimizing the development of restrictive scar tissue that is so detrimental to tendon excursion and normal joint motion. Whether the injured part is immobilized or mobilized depends on the current phase of tissue healing. Static orthoses are generally made to protect healing structures such as a fracture, a collateral ligament strain or repair, but are also used effectively to decrease pain during functional activity with a diagnosis such as CMC arthritis or tendonitis.
The advantages of custom fabricated orthotics are:
- Removable for wound care, bathing, or gentle exercise if appropriate.
- Easily adjusted if uncomfortable
- Any position requested can be achieved with the low-temperature plastic
- Able to clean as needed
- Can get wet
- Adjustable as swelling decreases or as able to get into a better position
Made to immobilize only necessary joints, keeping free joints that can be moved to keep from getting stiff Orthotics that are fabricated by a hand therapist are made from a low temperature plastic. The raw material comes in 18”x24” flat sheets. There are many different types of material that provide us with a variety of physical properties i.e. thick, thin, rigid, conforming, stretchy, smooth or perforated. The therapist chooses the material that will provide the characteristics needed for the requested splint. For example, a forearm fracture orthosis would require a rigid, more supportive material where as a hand based thumb spica orthosis for CMC arthritis can be thin, yet supportive and less rigid, fitting more like a glove and allowing near full function. A pattern is developed, the material is heated in hot water (160°), the material is cut and trimmed to fit, and then molded to the patient.
At Hand Therapy Specialists our therapists have an average of 16 years of experience making orthotics and treating patients with shoulder, elbow, wrist and hand disorders. There are days a therapist may make 10 splints in one day. Due to our expertise we assure you we are able to fabricate the orthotic needed for your patient. We also understand the need to get patients in immediately for these types of injuries. We assure you we will get your patient in within 2 days of phoning us, but if you have a patient in your office with an immediate need that you do not feel can wait, give us a call and we will get them in that same day.
Part II will cover the use of static progressive orthotics tissue growth. Part III will cover unusual orthotic needs for function and complicated injuries.
*Correct Terminology ~ Splint or Orthotic
As a result of the Medicare Modernization Act of 2003, CMS developed new quality standards for DMEPOS suppliers and due to this you will see that our terminology has changed from the term splinting to ORTHOTICS. (These standards were developed to ensure that qualified professionals were fabricating or providing Durable Medical Equipment, Prosthetics, Orthotics and Supplies [DMEPOS]). Occupational Therapists are eligible providers due to our practice act that states: “Specific occupational therapy services includes but is not limited to: …the design, fabrication or application of selected orthotics or prosthetic devices…” 675.210.