Each Quarter (January, April, July October) we will highlight a splint, device or other clinical tip or endeavor that has been created to work with a challenging surgical intervention or as a result of a unique patient need or request. New designs as well as modifications to an existing, established designs are welcomed. Post-operative splints as well as adaptive device splints, casting and any other type of ADL modification or overall clinical highlight that helps facilitate best practice in burns gladly are welcome. We will also be archiving all of the submissions so that we can maintain a resource of burn splinting knowledge. Contribute to the accumulated knowledge and submit your splint design to today!
Training Dowel
Submitted By: Kimberly H. Hill, COTA/L
Department of Rehabilitation Medicine
New York-Presbyterian Hospital/Weill Cornell Medical Center The University Hospital of Columbia
Description of positioning device:
A simple, comfortable device to initiate patient participation in activities of daily living and assist with pre-prosthetic training
Materials used/needed:
| *1/2 sheet thermoplastic material 12x18” | *1 inch wooden dowel |
| *1” Velcro | *Self adherent wrap |
| *1” Strapping |
Fabrication instructions:
Advantages:
Disadvantages:
Indications:
For patients with unilateral or bilateral below elbow upper extremity amputations
Precautions/Contraindications:
Non healed wounds or incisions
Clinical Reasoning:
This splint was originally designed for a patient with bilateral upper extremity amputations. While recovering in the ICU, the therapists discovered the patient was aware enough to call the nurse for basic needs. Initially, this device was fabricated for the patient to push the button to call for the nurse.
As the patient progressed in therapy, the patient was able to use the device for many other activities such as opening a door, turning on and off a light switch, writing and painting, and dialing the phone.
Level of Skill Required:
Intermediate splinting skills are required
Total Time Required to Fabricate Splint / Device:
45 minutes
Primary reference:
Fletchall, S. (2005). Returning Upper-Extremity Amputees to Work. Retrived
January 30, 2006, from The O&P Edge Web site:
http:/www.oandp.com/edge/issues/articles/2005-08_04.asp
Supporting references:
Lake,C. (1997). Effects of Prosthetic Training on Upper- Extremity Prosthesis Use. Journal of Prosthetics and Orthotics, 9(1), 1-4.
If you have any questions about the design of the splint or comments about the fabrication, please contact Kimberly either by phone: (212) 746-1598 or by email: khh76@aol.com
Upper Extremity Pre-prosthetic Adaptive Device
Submitted By: Joy D. Nelson, COTA/L, SGT
United States Army Institute of Surgical Research
Fort Sam Houston, TX
Description of positioning device:
The idea for this device came about from working with a patient who suffered the loss of all four extremities as a result of his burns. He was unable to participate with any aspect of his care, and was growing increasingly frustrated as a result. Because his wounds wouldn’t tolerate a typical socket-based device, I used a clamshell design for the base of the splint to allow the circumference to adjust with the changing sizes of his residual limb. Training the patient to use the device took less than 15 minutes, and by the end of the day he was able to use it to feed himself and brush his teeth. By the next day, he had requested multiple other terminal attachments, and was using the device to perform a multitude of small tasks for himself.
Materials used/needed:
| *Hydrocollator | *Universal cuff | *Hammer/mallet |
| *Polyform® splint material | *Therasponge | *Eyelet |
| *Rotary hole punch | *Super Glue | *Flathead screwdriver |
| *Heat gun | *2 motion stops | *Scissors |
| *50lb test monofilament | *Straight outrigger bar | *Buckle Straps |
| *Large Phoenix Hinge kit | *Screw with wing nut | *Moleskin |
| *2 rubber band posts | *Speed rivets | *Small rubber band |
Fabrication instructions:
The main structure of the device is now complete. Various attachments now can be fabricated to meet the patient’s needs. Shown below is a toothbrush and spoon attachment.
Toothbrush Attachment:
Materials needed – toothbrush with a hole drilled in the handle, outrigger bar, screw, wing nut.
Attach the toothbrush to the outrigger bar with the screw and wing nut as shown below:
Utensil Attachment (shown with spoon):
Materials needed – spoon with hole punched/drilled in handle, outrigger bar, screw, wing nut.
Attach the spoon to the outrigger bar with the screw and wing nut as shown below:
To place the attachments on the Upper Extremity Adaptive Device, slide the outrigger bar into the pocket of the Universal Cuff as shown below:
Video clips of device in use: Video 1 Video 2 Video 3
The splint is placed on the patient’s residual limb as show in the pictures above. Tuck the sponge anchor into the patient’s waistband, attach it to a belt-strap, or otherwise secure in the vicinity of the patient’s waist. The device is operated by having the patient move his/her arm through shoulder flexion and/or abduction to flex the elbow and move the terminal device into the desired position for functional activities. The length of the monofilament can be adjusted to accommodate for increase or decrease in range of motion of the residual limb.
The motion stops can be secured in various positions to lock the elbow in one position in order to allow the device to be used for other activities, such as writing, typing, changing television stations, to name a few. Other terminal attachments can be created as necessary to fit the patient’s needs.
Advantages:
Can be used immediately post operatively for functional activities. The clamshell design allows the splint to be adjusted to accommodate edema, pain, and dressing changes. Shoulder motion required to power the device is similar to motion required for prosthetic use. Device is lightweight with minimal training time for patient use (approximately 10-15 minutes).
Disadvantages:
Device can be used for lightweight tasks only. Fabrication can be somewhat time consuming (approximately 1 to 1 ½ hours).
Indications:
Above elbow amputation with adequate residual limb length (4-6 inches of residual limb length or more) with the ability to actively move residual limb. Patient must be alert and able to follow directions.
Precautions/Contraindications:
“short” residual limb (less than 4 inches), wounds, altered mental status, pain.
Level of Skill Required:
Intermediate to advanced.
Total Time Required to Fabricate Splint / Device:
approximately 1 to 1 ½ hours, including 1-2 attachments. Additional time required to fabricate other attachments as indicated.
If you have any questions about the design of the splint or comments about the fabrication, please email Joy at: joy.nelson@us.army.mil
2007
|
January 2007 Dorsal Wrist Extension Fulcrum Splint |
April 2007 Low Load Horizontal Mouth Splint |
|
July 2007 Focused Rigidity Resting Hand Splint |
October 2007 Bucks Positioning for U/E’s |
2006
| April 2006 Simple Static Progressive Opposition Splint |
July 2006 A Dorsal-Volar Burn Hand Splint |
|
October 2006 Shoulder Depressor Sling (Estes Sling) |