Professional Documents
Culture Documents
Instrument Criteria
Detailed history
o Interview of pt, relevant persons,
medical chart
Obs of posturing and use of the hand
Skin and soft tissue condition
Skeletal and joint stability
Composite motion
Strength and musculo tendinous continuity
Pain
Neurovascular Status
Subjective
Demographics
Diagnosis
o Design of splint
o Length of treatment
Mechanism and onset of history
Other pertinent medical hx
o Diabetes
o Hypertension
Received treatment of medications
Precautions
Results of pertinent ancillary procedures
Subjective info
Occ profile
Difficulties in role participation
Handedness
Generalized sensation
Pain
Objective Information
ROM
Muscle strength
Sensory eval
Grip pinch
Hand coordination/dexterity
Edema
Hand deformity
Functional capacity
Position of extremity
Effect of fatigue
Physiologic adaptation
Length of test
Motivation
Diagnosis
o Ex. ALS pt in relapse
Physiologic timing
o Stage of inflammation
Pts response to the app of the splint
Should include:
o
o
o
Diagnosis
Date and reason of injury
Other pertinent medical hx
o
o
o
2.
3.
Height
Pliabilit
y
Skin color
o Black: ischemia
o White: maceration
o Red: rubor
o Blue: cyanosis
o Yellow: jaundice
Sensation
Temperature
o Heat: inflammation
o Cold:
Texture and moisture
o Gangrene is the death of tissue in
part of the body
o No sweat: layers of the skin*
** Nail beds are always free when
bandaged
4.
Normal
1
2
3
Pink
Red
Purple (circulation is a problem
Supple
2
3
4
Yielding
Firm
Adherent
0
1
2
3
4
Normal
1-2mm
3-4mm
5-6mm
>6mm (Worst)
5.
Joint
Immobilization = protection
Immobilization or blocking splints are used to protect
healing until tensile strength is sufficient to tolerate
motion and resistance
Normal
Identify
6.
7.
Nerve
8.
Vascular status
Monitor skin temperature, color and composite
mass and size of extremity
Check for edema
o Fluctuationg edema splint should be longer
(T sling)
9.
Function
Volume
o Thru volumeters
o Circumferential measurements may also be
taken at predetermined levels using tape
measure or calipers
Vessel capacity
o Use of Doppler scanner (map arterial flow
thorugh audible and ultrasonic response to
arterial pulsing)
Detection
o The most fundamental level on the sensibility
continuum is the ability to perceive a single pt
stimulus from normal background stimuli
(Semmes-Weinstein)
3.
4.
Other Considerations
Splint care
Non-acute inflammation extremity can be moved to reduce the
inflammation
2.
Diminished flexibility
Due to changes of collagen, decreased activity leading
to stiffness, effects of disease (ie arthritis) and possible
dietary deficiencies
Implication: static splints may lead to faster joint
stiffness
Static splints for stiffening of joints; do not put
splints on for too long
o Bigger bones = thicker splints
Diminished muscle strength
Decrease in number & size of muscle fibers
Decrease in number of motor units
Affect coordination and speed of muscle contraction
Implication: splint design should be lightweight;
weakness may interfere with the ability to don and doff
splint
3.
4.
5.
6.
7.
8.
9.
Thinner splints
Leather straps
Pathologies
o arthritis, dupuytrens cc; overuse conditions
such as CTS, Trigger finger
Physical and social contexts
o greater risks for falls due to balance,
coordination, visual and environmental
changes
o greater risk for fractures due to osteoporosis
o * consider the implication of splint---does it
contribute to fall?
o Elders could become confused with changes in
their immediate environment, especially at
night
o Splint use can compound the issue if the hand
is not free to reach out in protection (ie unable
to manuveur bedsheets and could become
tangled; can also be frustrating)
o Availability of caregiver (living alone or with
family)
Consider social context
o Embarrassment ( as a sign of weakness)
may affect compliance with wearing
o Cosmesis (including size and profile) is
also important
Edema
Trauma
congestive heart
failure
dependent positioning
IV infiltration
prolonged
immobilization
Ecchymosis (bruise)
Trauma
anticoagulants
fractures
Applications to Splinting
Reduce edema
before applying splint
Padding
Monitor splint
frequently for
pressure areas
Soft straps
Avoid transverse
Fragile skin
Dehydration
DIabetes
Renal disease
Psoriasis
radiation therapy
advanced age
Joint Contracture
Fractures or other
orthopedic conditions
poor positioning
prolonged immobility
Diminished cognition
Dementia,
alzhiemers disease
CVA
Multi-infarct dementia
over medication
depression
Sensory loss
Diabetes, CVA
Peripheral vascular
disease
Motivation
Depression
dorsal straps
Padding
Monitor for pressure
areas
Soft straps
Synamic or static
progressive splints
Splint to regain
functional position
Bases
Design choices
Precautions/Contraindications
Sensation
To accommodate edema
To provide leverage to control tightness and
allow easier application*
5.what do you recommend to help sadie grasp her walker?
A. Building up the handle of the walker by using
adhesive foam
B. Using walker splint*
C. Using neoprene thumb support
6. How might the diagnosis of DM affect splinting of this frail
older woman?
A.
B.
C.