HIMAKSHI BHATTACHARYA
SPLINT:
An orthopedic device use to immobilize and support the body part is
termed as splint.
BRACE:
Brace is a device fitted to the body part which is weak and injured to give support.
Eg: Knee brace for OA.
LOCATION
DIRECTION
PURPOSE
TYPE
Textbook of Rehabilitation: S Sunder, Susane O sullivan
SPLINT DESIGN
1) Static Splint
2) Serial Static Splint
3) Drop out Splint
4) Dynamic Splint
5) Static Progressive Splint
THIS TYPE OF SPLINT HELPS IN REGAINING MOVEMENT REDUCING PAIN WITH NOT OVER
STRESSING THE TISSUE.
FOR MOBILITY
AND ENHANCING
FUNCTION.
Prefabricated splints are the splints which are made commercially for various
material and styles.
As the demand is less so they are not made as frequent as alteration in market is
common so these are not made in bulk.
People who approach this type of splints are rare.
2) Mechanical Advantage:
Splint incorporate lever system, which incorporate forces, resistance, axes of
motion, and movement arm.
Lets understand it with an example:
Volar based wrist cock up splint here for mechanical advantage forearm length is
made longer so splint has better pressure distribution support and comfortability.
3) Direction of stress:
There are three direction of force to act:
1) Tension
2) Compression
3) Shear
Tension occur when forces both are acting on opposite direction.
Compression occur when force acting in same direction
Shear force occurs when parallel forces are applied in equal and opposite direction.
4) Torque:
It is biomechanical principle defined as rotational effect of mechanism. Torque is
the production of the applied force multiplied by perpendicular distance from the
axis of rotation to the line of application. Most important for dynamic splint.
5) Repetitive Stress:
If repetitive stress is applied in moderate amount may lead to breakdown and
damage to skin. So to avoid that traction must be release to avoid unnecessary
tension and well distributed pressure.
These are basic principles of orthosis.
So, in this case orthosis management would be moving the line of gravity to center
that is close to joint line. Which can be achieved by modifying the limb movement
during gait.
This is done in two way:
1) By altering angular relationship with plantar surface of foot and floor
2) By altering the angular relationship with most distal joint.
shoulder
Textbook of Rehabilitation: S Sunder, Susane O
sullivan
FIGURE OF EIGHT AXILLA WRAP
– Indication:
1.) Axilla Burns or skin grafting
2.) Shoulder Adduction Contracture
3.) Kyphotic Posture
4.) Clavicle Fracture
Objectives:
Objectives :
1) To stabilize ulnar fracture
2) To promote healing without immobilizing any joint
3) To protect fragile bone from fracture
Indications:
1) Midshafts Ulnar Fracture
Indications:
1) In Posterior Glenohumeral Instability.
2) Partial Brachial Plexus injury and brachial neuritis
3) Rotator cuff repair
Indication:
1) Brachial plexus injury
2) Shoulder Adduction Contractures
3) Complete supraspinatus tear
4) Axilla burns or skin grafting
4) Static Shoulder Elbow Wrist Sling
Common Name: Hemi arm sling
Objectives:
1) To immobilize Shoulder and Elbow
2) To support the weight of the upper extremity across the contralateral
shoulder, without stress on neck and back
3) To prevent Brachial Plexus Traction
4) To prevent pain and shoulder subluxation
Objectives:
1) To prevent or correct elbow flexion contractures
2) To block elbow Flexion
Indications:
1) Burns
2) Ulnar Nerve Entrapment
3) capsular Tightness
4) Elbow surgeries like:
Triceps rupture
Tumor resection
Total Elbow
Textbook Arthroplasty.
of Rehabilitation: S Sunder, Susane O sullivan
ELBOW FLEXION HARNESS
4) Supracondylar fracture
5)Radial head fracture
Objectives:
1) To reduce pain and inflammation
Indications:
Inflammation of common Tendon origin
It is static in nature.
Common Name:
1) Volar/Palmar Wrist splint 7) Work Splint
2) Volar Wrist Cock up splint 8) Ulnar Gutter Splint
3) Wrist Immobilization Splint 9) Radial Gutter Splint
4) Drop Wrist Splint
5) Carpal Tunnel Splint
6) Wrist Extension Immobilization Splint
Objectives:
1) To reduce Pain and Inflammation
2) To protect against joint damage
3) To promote hand function
4) To prevent or correct contractures
5) To provide base for Outriggers
Indications:
1) Tendinitis/Tenosynovitis of wrist tendons
Objectives:
1) To Passively extend the wrist while allowing active wrist flexion
2) To prevent contracture of unopposed innervated wrist flexors
Indications:
1) Weak or Paralyzed wrist Extensors (e.g.. Radial Nerve Palsy)
Common Name:
1) De Quervain’s static splint
2) Wrist and thumb static splint
3) Long thumb CMC immobilization splint
4) Long opponens splint
5) Radial-thumb gutter splint
6) Wrist Thumb Orthosis
Objectives:
1) To immobilize wrist, thumb CMC, MCP Joints, which are crossed by inflamed
tendons
2) To rest and reduce inflammation
Indications:
1) De Quervain’s tenosynovitis: Inflammation of tendon of abductor polices longus
and extensor polices brevis in their synovial sheath
Objectives:
1) To immobilize the wrist, thumb, CMC and MCP Joints
2) To rest hand to reduce inflammation
Indications:
1) De Quervain’s tenosynovitis
2) Instability of joints
3) Scaphoids fracture
4) Bennett’s fracture (fracture of base first MC joint)
Objectives:
1) To immobilize the wrist and Finger MCPs
2) To relieve pain and inflammation
3) To prevent and correct deformities
4) To correct joint instability
Indications:
1) Joint Inflammation
Objectives:
1) To gently stress the MCP collateral ligaments to promote desired growth and
increase flexion range
Indications:
1) Extension contracture of MCPs caused by shortened collateral ligaments
1) Scleroderma
2) Dupuytren’s release
3) Boxer’s fracture (Base of 5 MCP fracture)
4) Burns
5) Inflammatory joint disease
7) Crush injury
Objectives:
1) To prevent flexion contractures
2) To reduce tone of hypertonic muscles
Indications:
1) High tone Associated with:
Head Injury
Cerebral Palsy
Multiple Sclerosis
Cerebrovascular Accident
Objectives:
1) To train a tenodesis grasp
2) To promote tripod pinch
Indications:
1) Quadriplegia at level of C6 with at least grade 3 strength of the wrist extensors
This splint is a functional aid for such patient which uses extensor carpi radialis
muscle giving potential grasp by reciprocal wrist extension and finger flexion.
Objectives:
1) To position wrist in static extension and passively extend the MCP and IP while
permitting limited active flexion of MCP
Indications:
1) Extensor tendon Laceration
Common Name: Dynamic Anticlaw deformity splint, dynamic ulnar nerve splint,
Wynn Perry Splint
Objective: To passively flex the MCP of fourth and fifth finger and to allow active
extension.
To correct Hyperextension
To prevent shortening of MCP
TO promote active IP Extension
Objective: To apply gentle prolonged stretch to the contracted PIP capsule and
ligaments to promote growth of the shortened tissues and restore extension ROM.
Indication: Flexion Contracture Of PIP joint
1) Umit Urgulu et all . In their study shows use of dynamic orthosis over static
orthosis it provides definite amount of function to the limb as well as support
where as static orthosis provide support but function ignored.
2) Mike S Macgrath et all. In their study shows that use of static progressive splint
is increasing now a days using a static splint for whole day give rise to other
complication where as these splints help to improve restricted motion, provide
support, enhance mobility with minimizing stress.
3) Use of upper limb exoskeleton over dynamic splints help to enhance body
function of individual in targeted form without adding complication of
splinting.
4) Mozghan Nazaffi et all. use of spiral splint instead of traditional splint use in
tennis elbow reduce pain improves grasp and functional abilities.
5) Lee Anee Chazen et all. In their study shows use of splint for spasticity of upper
limb may help to reduce tone it is even helps to rest the hand.
1) Joint Mobility
2) Limb Length
3) Muscle Function
4) Sensation
5) Upper limb strength
6) Psychological status
7) special Life style considerations
4) Toe spring: It is the space between the outer sole and the floor, which helps to
produce a rocker effect during toe off phase of gait cycle.
If a lift is added to sole it compensate LLD.
5) Heel: Is the posterior part of the sole, which corresponds to the heel of the foot.
Since it is the portion where most of the body weight is taken it needs to be resilient
and thicker so that it can prevent shoe components from wearing out and shifts weight
to the fore foot.
UPPER PART COMPONENTS:
1)Quarter: This is the posterior portion of the shoe upper. A high quarter is referred as a
“high top” and is used by runners and footballers for greater sensory feed back
The AFO is a boot to which an ankle joint is fixed through the stirrup. The metal
uprights are ascending up to the calf region.
COMPONENTS ARE:
1) Proximal calf band with leather straps
2) Medial and lateral bars articulating with ankle lateral and medial ankle joints.
3) medial and lateral support can be give.
There are five types of artificial ankle attached to foot orthosis:
1) Free ankle: Given when ankle power is normal
2) Limited Ankle joint: Is prescribed when the muscle operating ankle jjoint are fliai
or has no power.
3) 90* foot drop stop: Is prescribed when the ankle joint allows dorsiflexion but
stops short at the neutral position that is 90*. So does not provide plantar flexion.
Prescribed in case of foot drop. When plantar flexors are normal but Dorsiflexors
are weak or when plantar flexors are spastic and Dorsiflexors are normal.
4) Reverse 90* Ankle joint: This ankle joint which allows plantar flexion but stops
short at the neutral at 90*. Does no allows dorsiflexion prescribed to prevent
calcaneal deformity.
Fixed Ankle Joint: Sometimes the foot needs to be protected and weight is taken
off injured portions as in fracture calcaneus when in combination with a weight
relieving orthosis it takes the weight off the foot. It is not commonly used.
INDICATIONS:
1) Dorsiflexors Muscle Paralysis
AIM: To prevent contracture of the Achilles Tendon , and to assist dorsiflexion assist
dorsiflexion during heel strike a dorsiflexion assist plastic posterior leaf spring AFO can be
prescribed that can be inserted in shoes. For easy foot flat without undue knee flexion.
2) Ankle and Foot Paralysis:
This is prescribed to provide stability and reduce gait deviation during the swing and stance
phases. A polypropylene solid ankle foot orthosis to be worn with a shoe prevent foot from
dragging during swing, the brace rigidity prevents ankle dorsiflexion during midstance. AFO
can be used with straps for valgus and Varus deformity.
3) Spasticity:
AFO are used in children with cerebral palsy to stabilize the foot during heel strike
and foot flat phase. It prevents toe drag and plantar flexion during swing phase.
4) Limited Weight Bearing:
This is rare indication of AFO. To reduce loading on the leg and foot in conditions
where foot is need to be protected (e.g. calcaneal fracture) . The socket is provided
at patellar tendon bearing area so weight can be barred and heel can be offloaded.
Acute burns
Cerebral palsy
Flaccid Hameparesis
Foot drop
Plantar Fasciitis Night use
Joint inflamation
The Posterior Leaf Spring (PLS) AFO is a dynamic thermoplastic AFO designed to
accomplish two things:
• Support the weight of the foot during swing phase as a means of enhancing
swing limb clearance
• Assist with controlled lowering of the foot during loading response in stance as
part of the first/heel rocker
INDICATIONS:
1) UNSTABLE FRACTURE OF PELVIC RING
2) FRACTURE OF ACETABULM WITH
MINIMAL DISPLACE MENT
3) FRACTURE OF FEMUR
4) COMPLICATED FRACTURE
5) COMMUNITED FRACTURE OF TIBIAL
PLATEAU
6) TIBIAL PLATEAU FRACTURE
Components are same as AFO. In addition to this there is upright extended from
knee joint to thigh. Thigh band are suspension mechanism to which the uprights
are attached.
Knee Joints Are: This are provided so wearer can sit and can have good gait pattern
to avoid stiff knee gait pattern.
1) Straight set knee joint: Allows free flexion and prevents hyperextension. Upper
segment rotates in single transverse axis. It is used in combination with drop lock
to give stability. It is cheap and easy to repair.
2) The polycentric Knee joint: Use double axis system to stimulate the
flexion/extension movements of femur and tibia at knee joint.
3) Posterior Offset Knee Joint: This is given for patients with minimal quadriceps
weakness, since it keeps the knee extended, though there is not enough stance
control. There must be adequate power of hip flexion and extension and ability to
produce adequate momentum to walk. The placement of joint is just behind the
actual knee joint to provide stability.
4) Stance Control: The ideal joint should have stability during weight bearing and
flexion during the swing phase of gait when it is non weight bearing. This is more
energy efficient, decrease the exaggerated movements of hip when knee is locked.
Indications:
1) Muscle Weakness: weakness of lower limb controlling hip and knee.
Specifically hip extensors and quadricep. In spinal cord damage. Lower Motor
disease like poliomyelitis or injury to nerves.
2) Upper Motor Lesion: Normal Motor control is lost. So it is provided to achieve
stance stability.
3) Loss of structural Integrity: In inflammatory disease like RA or degenerative
disease like Osteoarthritis.
1) C Brace:
Changing speed and direction is easier when you can put weight on a bent knee. And,
the idea of “orthotronics” means you have the combination of electronic and
mechanical systems working together to support your every step. The C-Brace
orthotronic mobility system is designed to provide the highest level of support for
patient so they can feel confident with every step.
Objectives:
Stumble Control: Sensors recognize uncontrolled knee flexion and create immediate
stability so the patient can recover — and keep a stumble from turning into a fall.
Greater Ease and Less Concentration: The gait cycle is controlled dynamically and in real
time — allowing patients to walk with greater ease and less need for compensatory
Textbook of Rehabilitation: S Sunder, Susane O sullivan
movements.
FEATURES OF C BRACE
– The E-MAG Active is a stance control KAFO that is calibrated to the patient’s
step length. It is also simple to re-calibrate the E-MAG Active if the patient’s
step length changes over time. The stance control function will remain locked
during weight bearing, then unlock for swing phase. It simplifies gait training
and allows for varied cadence to help meet your patient’s specific needs. A
gyroscope built into the KAFO monitors your patient’s step length. During the
fitting process, the E-MAG Active’s calibrating feature allows it to recognize your
patient’s gait pattern.
Stance Control helps users achieve a more natural gait compared to locked KAFOs,
thereby reducing compensatory movements that can lead to degenerative
conditions, excess energy expenditure, and noncompliance. · Gyroscope monitors
the orientation of the user’s lower limb (whether it is at initial contact or at
terminal stance). · Extraordinarily simple calibration allows the Orthotist to
customize the unlocking feature during the fitting process. Varied flexion angled
joints can be used to ease locking/ unlocking of the orthotic knee joint or
accommodate knee contractures. · Optional manual locking/unlocking function
It is extension to KAFO. Its hip extension is to provide hip flexion and extension.
The suspension with pelvic band which fits between iliac crest and greater
trochanter to control rotational movement. The lateral extension stops at ischial
region. It helps in weight relieving. It helps in improving Postuure, and balance in
standing. Also during walking.
Uses:
Weak muscle controlling hip.
Can be possibly weak knee and ankle.
1) Bilateral HKAFO
2) Unilateral double upright HKAFO
3) Bilateral double upright HKAFO
These are bilateral hip, knee, ankle, foot orthosis to provide contralateral hip
extension and ipsilateral hip flexion.
1) Assist Gait
2) decrease weight
3) control movement
4) minimize progression of movement
1) Murrat Arrac et all in their study in 2016 showed powered limb orthosis can
be the best newer trend which works better in patient with paraplegia or
hemiplegia who cannot achieve sit to stand will enhance in better way.
2) Mukhtar Arzpour et all in their study said that stance control knee brace use
for knee support is better than traditional KAFO.
3) Zhenxiong Shawn Zhang in his article suggested that children using night splint
for CP shows quite improvement in gait
If abdominal compression is the basic goal a corset will suffice. It provide vertical
reinforcement.
It covers Lumbar and sacral areas. The biomechanics of corset is to increase
intraabdominal pressure which will in turn reduce stress on intervertebral disk.
This will does reduce frontal movement.
A Jewett brace is a hyperextension brace that prevents the patient from bending
forward too much. It is often used to facilitate healing of an anterior
wedge compression fracture involving the T10 to L3 vertebrae.
– The most-commonly prescribed brace for scoliosis today is the Boston brace.
Many people know the Boston brace as a type of thoracic-lumbar-sacral
orthosis (TLSO). Other types of Boston brace models do exist, such as a CTLSO
(TLSO with a neck extension) for a high thoracic curve, though they are not as
common.
– The Boston brace works by applying corrective pressure on the convex (outer)
side of the curve and cutting out corresponding areas of relief on the concave
(inner) side of the curve so the spine can migrate in that direction.
GAIL L DAUMIT et
all.
In their study
shows the
scoliosis
correction is
better In this
splint then
boston.
1) Collars are soft or semi rigid which provide minimal motion control. Most
common type is Philedelphia Collar which has mandibular and occipital extension
and rigid anterior strut.
Use for: Upper cervical injury and fractures
2) Four-Post cervical Orthosis:
It gives moderate control of motion
It has to anterior and two posterior uprights.
Two anterior upright connects sternal and mandibular plate
Two posterior upright connects thoracic and occipital plate
Textbook of Rehabilitation: S Sunder, Susane O sullivan
MINERVA ORTHOSIS