Principles of Splinting, Casting, & Bracing

● Splint is used for protection, correction, and to assist any part of the body. It is generally categorized as static and dynamic
● A static split is designed to support and limit joint activity. There are no moveable parts. It is commonly used for both upper and lower
extremities
● DYNAMIC splinting is designed to mobilize a joint by applying a moving force that can remain constant as the part moves. Commonly
fabricated for injuries involving the hand.
● The goal of any splint is to provide external force to counteract the imbalances of the internal forces where weak muscles are supported
while counteracting the pull of stronger muscles
● It functions as first-class lever systems with three pints of pressure acting on the extremity.

Splinting
● A therapeutic procedure used in the management of UE and LE conditions. Splinting is a combination of art and science where in-depth
knowledge of anatomy and kinesiology are essential in the design and construction of custom-made splints
● Splints are used for protection, correction, and assists any part of the body. It is generally categorized as static and dynamic
● A static splint is designed to support and limit joint activity. There are no moveable parts. It is commonly used for both upper and lower
extremities
● Dynamic splinting is designed to mobilize a joint by applying a moving force that can remain constant as the part moves. Commonly
fabricated for injuries involving the hand
● The goal of any splints is to provide external force to counteract the imbalances of the internal forces were weak muscles are supported
while counteracting the pull of stronger muscles
● It functions as first-class lever systems with three points of pressure acting on the extremity

● The term splint is used in burn care more often than orthosis, even though the terms and the devices they represent are nearly synonymous
● Material used in fabricating splints include thermoplastics, plaster, and elastomer compounds.

Airplane Splint
Orthosis
● An externally applied device used to modify the structural and functional characteristics of the neuromuscular and skeletal systems
● The simplest definition of an orthoss is any externally applied device to an existing body part that improves function
1. Stabilize weak or paralyzed segments or joints
2. Support damaged or diseased segments or joints
3. Limits or augment motion across joints
4. Control abnomrla or spastic movements
5. Unload distal segments
● Universal terminology that is agreed upon by the International organization for standardization(ISO) should always be used to describe the
basic device. All orthoses should be designated using ISO acronyms according to the joints or body segments involved, such as AFO for
ankle-foot orthosis or WHO for wrist-hand orthosis. This is simply the starting point for defining the device and generating the appropriate
prescription
● The prescription should also include specifics about materials and special designs, such as control features at each joint or segment

Reference: Lecture 1
Orthosis vs Splint
● What was known within the industry as a splint, brace, wrap, or support is now defined by CMS as an orthotic device or orthosis. Orthosis
is used to describe a single, rigid, or semi-rigid device that supports a weak or deformed body member, or restricts or eliminates motion in a
diseased or injured part of the body. It can be custom fabricated, custom fit or prefabricated
● Orthotics refers to the science of fabricating or fitting orthoses The American Society of Hand Therapists firmly believes the terms splint or
splinting should no longer be used by therapist who are fabricating or issuing an orthosis
● Orthotist: A person who, having completed an approved course of education and training, is authorized by an appropriate national authority
to design, measure, and fit orthoses (AAOS)
● According to CMS, a splint refers to casts and strapping material used for reductions of fractures and dislocations. Splints are used typically
in physician offices for applying a cast and need separate CPT codes when billing

Role of the Physical Therapist and/or Occupational therapist

● Participate in patient evaluation, particularly as related to functional ability, such as transfers, ambulation, stair climbing, and assistive
devices, in addition to assessment of other durable medical equipment such as wheelchairs and bathroom equipment participate in
generation of the therapy prescription
● Provide the therapy program, which may include strengthening, range of motion, ambulation, wheelchair mobility, self-care activities proper
use of orthotic device, therapeutic modalities, and home programs
● Share knowledge with other team members

Casting
● It is the process of applying external materials such as PIP bandage and the like moulded on a limb or anatomical structure to serve as a splint
(static cast) or to create a positive model of that limb
● Why the need for casting?
○ Total immobilization (fracture cases)
○ For rectification (applying appropriate pressure and relief)

Bracing
● It is synonymous with splinting and orthosis. A long leg braces is the old term for Knee-ankle-foot orthosis (KAFO), short leg brace is a former
term for Ankle Foot Orthosis (AFO)
● Spinal Brace such as Jewett Brace is a type of Spinal orthoses. Spinal Braces can be specified as Lumbo-Sacral Orthosis (LSO),
Thoraco-Lumbo-sacral Orthosis (TLSO) etc.

Reference: Lecture 2
Principles of Upper Limb orthosis
General objectives for upper Limb orthotic Intervention
1. Protection
● Immobilizes the joint, preventing any motion and promoting optimal joint alignment
2. Correction
● Apply force system to correct deformity or joint contracture
● Use an orthosis for px to be more functional
● Orthosis that supports the wrist and hands
3. Assist
● Assist movement of joints during functional activities when muscles are weak or paralyzed to promote function
● Ex: Promote gripping
○ To promote gripping, you have to extend the wrist
○ Use a device that would promote the gripping w/ the wrist extended

Orthotic Consideration in Joint Positioning

● Pathology
● Joint Biomechanics and Tissue Tension
● Function

Pathology
● Why should I consider pathology first?
● If the pathology dictates the position, should be considered first becue joint position may worsen certain pathology
● For example: Positioning the wrist in flexion may irritate the median nerve in the Carpal Tunnel Syndrome
○ Advice the patient to use an orthosis considering the pathology
Joint Biomechanics
● If pathology does not dictate joint positioning, then joint biomechanics can be considered
● For example: Positioning the wrist in neutral MCP joint in flexion and IP joints in fully extension, keeps the extensor tendon in tension and
flexor tendon will be slacken
● To balance the tension in the flexor and extensor tendons, the wrist should be positioned in extension to counter balance in flexion tension

Function
● If neither pathology nor joint biomechanics is an influencing factor, then joint positioning should facilitate function
● To enable function the position of the wrist, CMC of the thumb, MCPs and IP joints must be considered to enable the patient’s ADL
● Does the patient’s ADL involve gross power or fine prehension grip?
● For gross power grip, the wrist is positioned in extension about 35 degrees to create tension the extrinsic finger flexors to grip tightly.
● The objective of the orthosis is to immobilize the joints that the tendons cross wrist, thumb CMC joint
● The thumb should be immobilized in a position that will enable easy opposition

Principles of Force Application

Principles of Levers
● Application of biomechanical forces fall on a first-class lever system
● The lever system is composed of fulcrum, (fixed axis) and two arms the effort (force arm) and resistance arm.

Functional Orthosis because it promotes movement

Reference: Lecture 3
 ● The lever arm distal is short because of anatomical structures, as a result a relatively high force is required to generate sufficient torque to
extend the wrist joint

● The Force required to extend the wrist joint is applied to each side of the bending site (wrist axis), white the counter force is applied over
the bending site
● Biomechanically these force should be equal and balanced on each side of the joint axis

● The force applied on the strap would be equal to the force that you would like to position the joint with

Dynamic Orthosis
Components of Outrigger
● Energy storage materials; Elastic band, spring, spring wire
● Outrigger; Metal Bar, plastic tube, Spring Wire
● Finger Loop; Leather Cuff. Plastic Pad
● Various Design:
○ High profile
○ Low profile
○ No profile

Outrigger Device
● Is attached to a dynamic orthosis in order to facilitate joint motion
● Serves as the anchor or pulley for the traction mechanism or as a point of attachment for springs, rubber bands, or other energy-storing
materials

Designs of Outriggers
● High profile design
○ Medyo mataas sa joint
● Elastic bands are anchored to the end of the outrigger, which is positioned some distance above the limb (therefore “high profile”) to
ensure adequate excursion of the elastic

● Low Profile Desih

○ Outriggers are closer to the hand
○ Changed from being the traction anchor to being a pulley to redirect the traction force

Reference: Lecture 4
 ● No profile design
○ The most compact dynamic orthoses have no profile
○ The extension fe is exerted through joint-aligned coil spring

Reference: Lecture 5