Presentation on theme: "Splinting Material, Processes, Tools and Techniques"— Presentation transcript:
1Splinting Material, Processes, Tools and Techniques Chapter 3
2Is Splinting the answer? Use the Clinical Reasoning approach…Activity analysis approach…Anatomy and biomechanics…
3Purposes of splinting Improve position Prevent deformity/contracture Correct deformity/ contractureProvide rest to a joint b relieving stressMaintain skeletal alignmentImprove functionPosition extremity for improved function
4Continued… Assist weak movement Substitute for absent movement transfer movement from one joint to anotherAssist muscle re-education and exerciseimprove independence in activities of daily living
5Splinting materials Low- temperature thermoplatic (LTT) material Soften in water heated btw 135 F and 180F (57º - 82º C)Therapist can put safely on patient’s skin while plastic is still moldableHTT material warmed to >250 F, cannot touch skin
6LTT often used to adapt devices for improving function Example?
7Polycaprolactone (PCL) is a biodegradable polyester with a low melting point of around 60°C and a glass transition temperature of about −60 °C. The most common use of polycaprolactone is in the manufacture of speciality polyurethanes. Polycaprolactones impart good water, oil, solvent and chlorine resistance to the polyurethane produced.This polymer is often used as an additive for resins to improve their processing characteristics and their end use properties (e.g., impact resistance). Being compatible with a range of other materials, PCL can be mixed with starch to lower its cost and increase biodegradability or it can be added as a polymeric plasticizer to PVC.Polycaprolactone is also used for splinting, modeling, and as a feedstock for prototyping systems such as a RepRap, where it is used for Fused Filament Fabrication (similar to theStratasys' Fused Deposition Modeling or FDM technique).
8PCL also has many applications in the hobbyist market (sold under various tradenames, such as "InstaMorph", "Friendly Plastic", "ShapeLock", "PolyMorph", "Plastimake", "Plaast" etc). It has physical properties of a very tough, nylon-like plastic that melts to a putty-like consistency at only 60 °C. PCL's specific heat and conductivity are low enough that it is not hard to handle at this temperature. This makes it ideal for small-scale modeling, part fabrication, repair of plastic objects, and rapid prototyping where heat resistance is not needed. Though molten PCL readily sticks to many other plastics, if the surface is cooled, the stickiness can be minimized while still leaving the mass pliable.
9Material selection Patient population Diagnoses Therapist preference Availability
10Material selection Decisions on the best material are based on: Cost Properties of thermoplastic materialFamiliarity with splinting materialsTherapeutic goals
11Handling characteristics Performance characteristics Material properties When heated and softenedPerformance characteristicsMaterial properties after the material hardens and cooled
12Handling Characteristics of Splinting Materials Low Temperature ThermoplasticsWarm water for consistent and overall coverageHeat gun for spot heating or dry heatAdvantage: Can work with material directly on skinDisadvantage: May melt in hot car or if left near hot surface
13MemoryAbility of the material to return to former size, shape and thickness when re-heated (ranges from 100% to little or no memory)100% memory (turn clear): return to the same thickness &sizeAdvantage: easier to "start over" novice therapists, serial splinting (spastic)Disadvantages: Constant molding required during the cooling process. May "shrink" during cooling (Spot heating)Constantly moulded throughout the cooling process
14DrapabilityAbility of material mold intimately over contours of extremity without manual assistanceDegree of ease with which the material conforms to the underlying shapeAdvantages: conforms wellDisadvantages: Prone to fingerprints of therapist, Poor memory, Stretches and "grows", Requires cooperative patient, Requires a light touch
15ElasticityMaterial’s resistance to stretch and tendency to return to it’s original shape after stretchAdvantages: Can tolerate a heavy touchGood with uncooperative patient, high tone, when including multiple areasDisadvantages: Difficult to mould to contours
16Self Bonding (uncoated) Ability to adhere (stick) to itself when heatedCoated material required bonding agentAdvantages: Can secure extra piece to the splint, such as when attaching a piece of hardware in dynamic splintDisadvantages: Difficult to take apart if the material foldsWhat is scoring?
17Self-finishing edgesEdge is smooth and clean when cut Decreases need to roll edgesAdvantages: less jagged edges, less risk for pressure sores
19Performance Properties of Splints ConformabilityFits intimately into contoured areasMore comfortablethey distribute pressure bestNo migration of splint on extremityHigh drapable
20Performance Properties of Splints FlexibilityAble to withstand stresses repeatedlyBends easilyExample?Circumferential splints
21Performance Properties of Splints DurabilityLength of time a material will last before becoming brittle with age
22RigidityStrongDoes not bend easilyMedium to large splintsTo support the weight a larger jointsIn small splint it is important if the splintIs to stabilize a jointMost LTT material cannot tolerate the repeated forces involved in WB such as in foot orthoses
23PerforationMoisture permeabilityAir exchangeMiniMaxiMicro perforatedReduce the weight of splintShould not be stretched. Increase the holesDecrease strength and pressure distributionCutting a perforated splint
24FinishTexture of the surface, smooth or grainy textureColourCommonly white but tanA variety of other colours are available in some productsBright colors with childrenColored with unilateral neglect
25ThicknessCommon thickness is 1/8 inchThis will soften and hardens faster than thicker materialThinner are used for children or for small splints and arthritis patients
26Sticky-backed VelcroBonds best when heated (dry heat) Rounded corners prevent "catchingPaddingBonds best when heated (dry heat) Changes fit of splint (smaller, tighter) Moisture and odor absorption requires replacement
27Splint fabrication Process Creating a PatternChoosing appropriate materialChoosing the type of tractionChoosing splint design for a given purposeFabrication
28Step 1: Creating a Pattern Necessary for successPattern should be madeStandard patternsTracing the outline of the hand (or body part)Position error (flat and neutral)Contra-lateral handLandmarks of handsDraw splint pattern over the outline of the handCut out the pattern
29Step 2: Fitting the Pattern to the client Fit the pattern on the extremityAdjust the size and shape by adding or subtracting from the pattern, using scissors and paper tame, so that the pattern conforms to the area to be covered by the splintPalpate through pattern material to find bony landmarks, borders, creases and skin folds, to provide cues to outline areaIf a pattern is cut much larger than necessary the splint will be difficult to mold. The pattern is easier to mold if cut true to size
30Step 2: Fitting the Pattern to the client Moistening the pattern paperMake a new pattern - major changesForm 3-1 hints for drawing and fitting a splint pattern
31Step 3: Tracing, Heating and cutting After making and fitting the pattern to the client, therapist place on material sheetTrace it with a pencil, grease pencilInk may smear into the plasticInk maybe removed with clorineCut with knife, or scissors (pattern maybe cut later .. Cut sheet into two halves
32Step 3: Tracing, Heating and cutting Electric fry pan (Sause pan)Temperature dial (160 F)Water high (two thirds full) or (2 inches deep)Take out of waterPut on mesh / flat clothCut pattern with long blade strokesDo not use the tip of the scissor
33Step 3: Tracing, Heating and cutting After cutting the pattern from the sheetPosition clientReheat the pattern
34Step 4: Position client Seat client comfortably for elbow and hand Gravity assisted.. Dorsum of hand on towel roll, Forearm in supinationOR: Hand in vertical positionStiff hand??Pain medications (30-60 min)
35Step 5: Molding the splint to client Retrieve material from waterWipe off any excess waterCheck how hot is the materialFragile skin?Material sticking to hair?Cold spray? Dip in cold water
36Step 6: Making adjustments Cut with scissorDip in hot waterHeat gun (off, cool, hot)Warm unevenlyDon’t use for major changesHot-cold lineAttachments
37Step 7: Strapping Velcro hook and loop With /without adhesive back Variety of width and clorsRounded corners of velcro?Adhesive on scissorsPadded strapsGive extra to clientAvoid losing straps fig 3-6
38Step 8: Padding To avoid pressure areas Heat gun and push away from bony prominence. (The ulnar head)Allow for padding space in the splintGel disksPut putty over prominence before applying materialReplacement (open cell padding)
39Step 9: Edge finishing If no self-finishing edges: Edges should be: SmoothRolledFlared outIf material cut hot.. Finishing of edges not neededUse heat gun or heated water in fry panSmooth finger prints with water
40Step 9: Edge finishing Finish Splint Edges Try these techniques to find which works best for you.Heat edges and trim with scissorsHeat edges and rub with a wet fingerEdges may be smoothed with an electric grinder or sanderDip in hot water until edges clear. Flare edges outward.Hardened edges may be trimmed with a deburring tool.
41Splinting precautions Alter splint if red areas on skin persist 20 minutes after removal of splintIncreasing surface area of splint decreases potential for pressure soresArm toughs should be 2/3 length of forearmTroughs should be ½ the circumference of body part
42Avoid pressure over bony prominences A pressure point should be bubbled out or enlarged rather than cut or paddedSmooth, rolled or rounded edges decrease pressure soresAddress moisture due to perspiration, wound drainage to avoid skin breakdown or infection
43Give careful consideration for the following: The needs and expectations of the patientPositionAreas to be supportedDistribution of support (total contact Vs. small areas of contact)Areas to be exposed
44Continued… Exposure of sufficient tactile surface for sensory input. Points and directions of forces.Movements which may be restricted by the splintEase of application and removal of splint.