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Aila Nica J. Bandong, PTRP University of the Philippines Manila College of Allied Medical Professions PT 150: Orthotics and Prosthetics.

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Presentation on theme: "Aila Nica J. Bandong, PTRP University of the Philippines Manila College of Allied Medical Professions PT 150: Orthotics and Prosthetics."— Presentation transcript:

1 Aila Nica J. Bandong, PTRP University of the Philippines Manila College of Allied Medical Professions PT 150: Orthotics and Prosthetics

2 At the end of the session the students should be able to: determine the classification used for upper extremity orthoses determine diagnostic indications for upper extremity orthoses determine the components and functions of upper extremity orthoses discuss several static splints describe dynamic splints enumerate the purposes for prescribing dynamic splints determine physiologic considerations in dynamic splints determine the basic components and functions of dynamic splints discuss several dynamic splints

3 Orthotist Physician Social worker Psychologist Patient Physical Therapist Occupational Therapist

4 Occupational Therapy Hand Rehabilitation Maximize residual function of the patient who has had surgery to, or an injury or the disease of the upper extremity Physical Therapy RA 5680 Section 16 Assess the need to use assistive device and train patients as called for Train patients to become functionally independent



7 MemoryDrapabilityElasticityBonding Self- finishing edges Heating time Working time Shrinkage

8 ConformabilityFlexibilityDurabilityRigidity Moisture Permeability and Air Exchange FinishColorsThickness

9 Type Static Dynamic Function Flexion Extension Abduction Adduction Rotation Region Volar or Dorsal Joints crossed * Finger / thumb splint * Wrist Splint * Wrist Hand Orthosis (WHO ) * Elbow (WHO) * Shoulder (Elbow- WHO)


11 Immobilize support Immobilize or support prevent deformity Help prevent deformity Prevent soft-tissue contracture Prevent soft-tissue contracture attachment Allow attachment of assistive devices Block Block a segment

12 C-Bar Connector bar Crossbar Cuff or strap Deviation bar and pan Forearm trough Anatomic bars Thumb post Thumb trough Blocks








20 Hypothenar Bar Lumbrical Bar Metacarpal Bar Opponens Bar



23 Lumbrical Bar Metacarpal bar Deviation Bar Forearm troughMetacarpal bar

24 Finger and thumb Orthosis DIP PIP Hand Orthosis Volar or dorsal hand orthosis Universal Cuff WHO Cock - up splint Resting hand splint Thumb spica Antispasticity splints

25 Fractures Tendon injuries Crush injuries Amputation Arthritis Carpal tunnel release Arthroplasty Tendon transfer Tumor excision Reconstruction of congenital defects Overuse syndromes Cumulative trauma disorders

26 Prevent or decrease edema Assist in tissue healing Relieve pain Allow relaxation Prevent, misuse, disuse and overuse of muscles Avoid joint jamming or injury Redevelop motor & sensory function

27 Type Static or dynamic Region Volar or dorsal Joint crossed Function Static Volar DIP Extension Splint

28 Static Three point orthosis for boutonniere deformity



31 Type Region Function Static Dorsal Hand Orthosis With an MP Block

32 Universal Cuff

33 Maintain the wrist in the neutral or mildly extended position Immmobilizes the wrist while allowing full MCP flexion and thumb mobility

34 Contraindications: Active MCP synovitis Joint inflammation resulting to volar subluxation and ulnar deviation Disadvantages: Interferes with tactile sensibility on the palmar surface of the hand Dorsal strap can impede lymphatic flow

35 Stronger mechanical support of wrist and freeing up some of the palmar surface for sensory input Distributes pressure over the larger dorsal wrist surface area Better tolerated by edematous hand



38 Immobilize to reduce symptom Position in functional alignment Retard further deformity

39 Forearm through Thumb through Pan C-bar


41 For burns: make adjustments as bandage bulk changes Preventing infection: when open wound has exudates, clean splints with warm soapy water, hydrogen peroxide, or rubbing alcohol Patients in the ICU: use sterile materials; follow protocol of the facility RA patients benefit from thin thermoplast ( less than 1/8 inch )

42 Help stabilize CMC, MCP and IP joints Thumb Post VolarVolar DorsalDorsal RadialRadial Gutter Gutter Opponens Bar


44 A review of studies conducted by Oldfield and Felson (2008) regarding the effects of wrist orthotic device use on pain and functionality in patients with RA reveal that the splints improved wrist pain and functionality without compromising dexterity

45 Platform design Volar based platform Dorsal based platform Finger and thumb position Finger spreader Cones

46 Static Dorsal Elbow Orthosis

47 Balanced Forearm Orthosis Forearm trough Elbow dial Rocker Assembly Distal arm Distal bearing Proximal bearing Bracket

48 Shoulder slings Humeral Fracture Brace

49 Airplane Splints


51 substitute To substitute for loss of motor function correct To correct an existing deformity controlled directional movement Provide controlled directional movement fracture alignmentwound healing Aid in fracture alignment and wound healing

52 Too great stretch Fatigued injury Failure Too little stretch Atrophy and weaken Skin, tendons, ligaments, and joint capsules will shorten in the absence of habitual tensile forces Enough stretchEnough stretch –Three degrees of gain in ROM per week, with a range of 1-10 deg, is acceptable (Cummings et al 1992 ) –High intensity short term stretching actually promotes stiffness –The client should sense tension in the tissues but feel no pain

53 Hepburn, 1987 The stretch should not be perceived as a stretching force until at least 1 hour has passed Client should remain comfortable with the orthosis for up to 12 hours After removal, the client should feel no more than a stiffness or mild ache

54 Outrigger Dynamic Assist Finger cuff Reinforcement bar Fingernail attachments Phalangeal bar/finger pan


56 Springwire finger coils Springwire knuckle bender Elastic bands




60 Finger hooks Contoured finger hooks

61 Dynamic finger extension splint Dynamic wrist extension splint Tenodesis training Dynamic ulnar nerve splint Capener Anti-microstomial splint

62 Dynamic radial nerve splint Objectives: Immobilize the wrist in functional position Passively extend the MCP to 0 Permit full active MCP flexion and unrestricted IP motion Indications: Paralysis of wrist, MCP, Finger extensors Advantages: Relatively has a less obtrusive shape as compared to the outrigger design The hand can be slipped through a loose sleeve with the orthosis on

63 Finger Cuff Dorsal Forearm Trough Dynamic Springwire Assist

64 Objectives: Passively extends the wrist while allowing wrist flexion To prevent contracture of unopposed, innervated wrist flexors Indication: Weak or paralyzed wrist extensors

65 Metatarsal Bar Dynamic Springwire Knucklebender Assist Volar Forearm Trough

66 Rehabilitation Institute of Chicago Objectives: To train tenodesis grasp To promote a strong tripod pinch with wrist extension Allows finger opening with wrist flexion Indication: C6 quadriplegia with grade 3 strength of wrist extensors

67 Finger Cuff Thumb Spica Forearm Cuff Dynamic Elastic Band Assist

68 Dynamic anti-claw deformity splint, Wynn Perry Splint Objectives To passively flex the 4th and 5th MCPs To prevent shortening of the MCP Collateral ligaments To promote active IP flexion Indication Ulnar nerve lesion

69 Metacarpal Bar Dynamic Springwire Knucklebender Assist Lumbrical Bar

70 Dynamic spring wire splint for PIP extension Objectives: To passively extend the PIP Allows active IP flexion Provide stability to PIP Promote restabilization of lateral bands and prevent rupture of the central slip Advantage no, profile minimizing its visual presence Indications - PIP flexion contracture - PIP dorsal dislocation - Volar plate injury - Flexor tendon repair with resulting PIP flexion contracture - Partial or complete tear of the collateral ligament - Boutonniere deformity

71 Thermoplast Dynamic Springwire Finger Coil Assist

72 Objectives: To apply stretch to tissues surrounding the oral cavity while permitting speech To prevent contractures of lip and buccal tissues that may lead to limitation in oral opening Indications: Facial and perioral burns Wearing regimen Continuously worn Taken off only for cleaning Precaution The commisures(corners) of the lips are prone to skin breakdown with improper fit and tension of the splint

73 Be aware of and make adjustments for pressure areas Check for presence of edema Timing Compliance Skin reactions


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