Splinting Material,

Processes, Tools and

Techniques

Chapter 3

Is Splinting the answer? Use the Clinical Reasoning

approach… Activity analysis approach… Anatomy and biomechanics…

Purposes of splinting Improve position Prevent deformity/contracture Correct deformity/ contracture Provide rest to a joint b relieving

stress Maintain skeletal alignment Improve function Position extremity for improved

function

Continued…

Assist weak movement Substitute for absent

movement transfer movement from

one joint to another Assist muscle re-education

and exercise improve independence in

activities of daily living

Splinting 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 moldable HTT material warmed to >250 F, cannot

touch skin

LTT often used to adapt devices for improving function

Example?

PCL 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.

Material selection Patient population Diagnoses Therapist preference Availability

Material selection Decisions on the best material are based

on:

Cost Properties of thermoplastic material Familiarity with splinting materials Therapeutic goals

Handling characteristics Material properties When

heated and softened

Performance characteristics

Material properties after the material hardens and cooled

Handling Characteristics of Splinting Materials

Low Temperature Thermoplastics

Warm water for consistent and overall coverage

Heat gun for spot heating or dry heat Advantage: Can work with material

directly on skin Disadvantage: May melt in hot car or if left

near hot surface

Memory Ability 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 &size

Advantage: 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

Drapability Ability of material mold intimately over

contours of extremity without manual assistance

Degree of ease with which the material conforms to the underlying shape

Advantages: conforms well Disadvantages: Prone to fingerprints of

therapist, Poor memory, Stretches and "grows", Requires cooperative patient,                          

Requires a light touch

Elasticity Material’s resistance to stretch and tendency

to return to it’s original shape after stretch Advantages: Can tolerate a heavy touch Good with uncooperative patient, high

tone, when including multiple areas Disadvantages: Difficult to mould to

contours

Self Bonding (uncoated) Ability to adhere (stick) to itself when

heated Coated material required bonding agent Advantages: Can secure extra piece

to the splint, such as when attaching a piece of hardware in dynamic splint

Disadvantages: Difficult to take apart if the material folds

What is scoring?

Self-finishing edges

Edge is smooth and clean when cut Decreases need to roll edges

Advantages: less jagged edges, less risk for pressure sores

Heating time Working time shrinkage

Performance Properties of Splints ConformabilityFits intimately into contoured areasMore comfortablethey distribute pressure bestNo migration of splint on extremityHigh drapable

Performance Properties of Splints FlexibilityAble to withstand stresses repeatedly Bends easily

Example? Circumferential splints

Performance Properties of Splints DurabilityLength of time a material will last before

becoming brittle with age

Rigidity Strong Does not bend easily

Medium to large splints To support the weight a larger joints

In small splint it is important if the splint Is to stabilize a joint

Most LTT material cannot tolerate the repeated forces involved in WB such as in foot orthoses

PerforationMoisture permeabilityAir exchange

MiniMaxi Micro perforated

Reduce the weight of splint Should not be stretched. Increase the holes Decrease strength and pressure distributionCutting a perforated splint

FinishTexture of the surface,

smooth or grainy texture

Colour Commonly white but tan A variety of other colours are

available in some products Bright colors with children Colored with unilateral

neglect

ThicknessCommon thickness is 1/8

inchThis will soften and hardens

faster than thicker material

Thinner are used for children or for small splints and arthritis patients

Sticky-backed Velcro Bonds best when heated (dry heat)

Rounded corners prevent "catching

Padding Bonds best when heated (dry heat)

Changes fit of splint (smaller, tighter) Moisture and odor absorption requires replacement

Splint fabrication Process

1. Creating a Pattern2. Choosing appropriate material3. Choosing the type of traction 4. Choosing splint design for a given

purpose5. Fabrication

Step 1: Creating a Pattern Necessary for success Pattern should be made Standard patterns Tracing the outline of the hand (or body

part) Position error (flat and neutral) Contra-lateral hand Landmarks of handsDraw splint pattern over the outline of

the hand Cut out the pattern

Step 2: Fitting the Pattern to the client

Fit the pattern on the extremity Adjust 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 splint

Palpate through pattern material to find bony landmarks, borders, creases and skin folds, to provide cues to outline area

If 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  

Step 2: Fitting the Pattern to the client Moistening the pattern paper Make a new pattern - major changes Form 3-1 hints for drawing and fitting a

splint pattern

Step 3: Tracing, Heating and cutting After making and fitting the

pattern to the client, therapist place on material sheet

Trace it with a pencil, grease pencil

Ink may smear into the plastic Ink maybe removed with

clorine Cut with knife, or scissors

(pattern maybe cut later .. Cut sheet into two halves

Step 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 water Put on mesh / flat cloth Cut pattern with long blade

strokes Do not use the tip of the

scissor

Step 3: Tracing, Heating and cutting

After cutting the pattern from the sheet Position client Reheat the pattern

Step 4: Position client Seat client comfortably for

elbow and hand Gravity assisted.. Dorsum of

hand on towel roll, Forearm in supination

OR: Hand in vertical position Stiff hand?? Pain medications (30-60 min)

Step 5: Molding the splint to client

Retrieve material from water Wipe off any excess water Check how hot is the material Fragile skin? Material sticking to hair? Cold spray? Dip in cold water

Step 6: Making adjustments Cut with scissor Dip in hot water Heat gun (off, cool, hot)

Warm unevenly Don’t use for major changes Hot-cold line Attachments

Step 7: Strapping Velcro hook and loop With /without adhesive back Variety of width and clors Rounded corners of velcro? Adhesive on scissors Padded straps Give extra to client Avoid losing straps fig 3-6

Step 8: Padding To avoid pressure areas Heat gun and push away from bony

prominence. (The ulnar head) Allow for padding space in the splint Gel disks Put putty over prominence before applying

material Replacement (open cell padding)

Step 9: Edge finishing If no self-finishing edges: Edges should be:

Smooth Rolled Flared out

If material cut hot.. Finishing of edges not needed

Use heat gun or heated water in fry pan

Smooth finger prints with water

Step 9: Edge finishing Finish Splint EdgesTry these techniques to find which works best

for you. Heat edges and trim with scissors Heat edges and rub with a wet finger Edges may be smoothed with an electric

grinder or sander Dip in hot water until edges clear. Flare

edges outward. Hardened edges may be trimmed with a

deburring tool.

Splinting precautions Alter splint if red areas on skin persist 20

minutes after removal of splint Increasing surface area of splint decreases

potential for pressure sores Arm toughs should be 2/3 length of

forearm Troughs should be ½ the circumference of

body part

Avoid pressure over bony prominences A pressure point should be bubbled out or

enlarged rather than cut or padded Smooth, rolled or rounded edges decrease

pressure sores Address moisture due to perspiration,

wound drainage to avoid skin breakdown or infection

Give careful consideration for the following:

The needs and expectations of the patient

Position Areas to be supported Distribution of support

(total contact Vs. small areas of contact)

Areas to be exposed

Continued… Exposure of sufficient tactile surface for

sensory input. Points and directions of forces. Movements which may be restricted by

the splint Ease of application and removal of splint.