What are splints?

Splints and casts are ‘external devices designed to apply, distribute or remove forces to or from the body in a controlled manner to perform one or both basic boy functions of; control of body motion, alteration prevention of change to the shape of the body tissue.’ Rose 1986

There are different types of splints, some splints are prefabricated which can work for some people, others can be made bespoke and are fabricated to meet individuals needs. Bespoke splints are made out of different types of thermoplastic material or soft and scotch cast (similar to people wearing a cast when they have broken a bone)

Thermoplastic splints:

Thermoplastic splint designs can be made for the hand and or wrist. The plastic is rigid to begin with. The occupational therapist will take a pattern of your hand / wrist and transfer this onto the material. The thermoplastic will be heated in a hot water bath until it is soft and mouldable. The thermoplastic can then be moulded to the desired position to either support or passively stretch particular joints. Straps and padding will be added as required.

Soft / Scotch casting:

Casting generally offers circumferential support around the joints and limb. These can be removable or serial. Serial means that the cast may be left on for a short duration of time i.e. 3 days to stretch the joint or limb prior to making the cast in a new improved position or making it removable after this initial phase of splinting.

Why would I need a splint?

Some people with a neurological diagnosis can experience a change in the function of their arm and hand. This may be that there is an increase of tone, so that hand and arm feels tight or a decrease in tone where the hand and arm can feel floppy. Sometimes in these cases there is a risk of losing range of movement and in the longer term contractures can develop. Some people experience pain and swelling associated with these changes. Occupational therapists will clinically reason through the risks and precautions associated with your upper limb presentation to make a decision regarding the indication for splinting. Splinting can be used with an aim to prevent or reduce the risk of development of deformities and contractures, splints can promote joint alignment and provide a low load passive stretch over a duration of time

Indications for splinting:

• Instability of joints – When a hand has increased or decreased tone the joints can be at risk, this can lead to deformity loss of movement and pain over time

• Associated reactions – After a brain injury a person may experience abnormal positioning and posturing of their upper limb which they cannot control, this may be present during effortful tasks such as walking or yawning. Splinting can aim to break this patterning

• Post Botulinum toxin (Botox) injections – As a result of a brain injury a persons upper limb can present with spasticity and increased tone. A consultant may recommend Botulinum toxin injections to reduce this presentation and the implications associated with this. Following these injections it is recommended by the Royal College of Physicians 2009 that the limb is splinted to achieve the optimum effect from this intervention

• Contracture management – If a joint is not able to be actively used in function and / or it is positioned for long periods of time in a restricted position there may over time be a loss of range of movement and increased risk of contractures. Splinting may be advised to reduce this risk and provide a low load passive stretch on the muscles and tendons

• Maintain and protect skin integrity – when a hand is held tightly closed it can become clammy and the skin in the palm or between the fingers can be at risk of poor hygiene and even pressure sores. Splinting can be used as an intervention to reduce the risk of skin breakdown

• Manage oedema – if the upper limb is poorly aligned or positioned some people experience some swelling in the hand, wrist and forearm. Thermoplastic Splinting can promote better positioning and alignment to reduce the oedema as part of a posture management programme at rest in the bed or wheelchair

• Reduce pain – Pain can be experienced if the joints are not supported, maligned from reduced or increased tone or if the hand is always held in a static restricted position. A splint can help to alleviate pain by promoting a more aligned position and providing a subtle gentle stretch to muscles

Prior to any splinting being carried out a full initial assessment will be undertaken, this will involve information gathering and a hands on assessment.

OT Partners can also offer a neurological hand therapy rehabilitation programme to work on upper limb function.