Yes, You Can Splint With Confidence! Neuro Splinting Tips for the “Non-Splinter”
We’ve probably all been there—you receive an order to fabricate a splint for a patient and you groan. You haven’t made a splint since OT school and you feel uncomfortable with your abilities to confidently create something, not to mention the amount of time it will take you to complete it!
Don’t fear—no need to call your resident CHT, you can do it! And you can even feel confident in recognizing hand impairments to recommend and create a splint for your patients or simply use thermoplast to your advantage.
This was me several years ago, and still is to some extent. I by no means am an excellent splinter—but my interest in dabbling in thermoplast molding continues to grow. Where I used to defer all splints to whatever CHT I was working with, I now feel confident to create a few and recognize conditions where patients may benefit from something custom made for exercise or to improve functional use of a neurologically-impaired hand.
And in the end, I’ve come to realize that splinting is turning into somewhat of a “dying art” for occupational therapists—which is sad! It’s a strong defining feature between us and other therapies and it would benefit us to maintain our skills!
So here goes…
A re-introduction to Splinting 101 with these Splinting Tips
First Stop: Say what? There are different types of thermoplast??
This was mind-blowing to me. How did I not know this? In an effort to expand my knowledge and comfort with thermoplast, a year or two ago I sat down with an experienced CHT for a quick lesson. She first described the different types of thermoplast available to use and the properties of each. Seriously, I had no idea—if I was taught this in OT school many moons ago I must have dozed off for that hour. But I’m determined to share the wealth:
Dull in appearance. Best bet for a newbie splinter—less “conformability” equals a longer working time for you! So if you are a slow splinter or nervous about making an ugly splint with lumps and bumps, this one is for you as it is the most forgiving. Good for use with spasticity. This one will also be more sturdy in the long-run.
Has a bit more shine to it when you compare to Orthoplast and is thinner as well. This means it may be more comfortable for patients, but also means it will not be as forgiving. You will have less time to fabricate, and it will show all the fingerprints, etc., if you do not obtain a smooth drape.
This medium density product is not as unforgiving as Polyform but allows for a bit more stretch than Orthoplast. You may recognize a variety of color options for Aquaplast, and TailorSplint is typically beige in color. Bonus: these do not stick to each other as bad as other options, so if you accidentally let material fold over on itself it won’t be such a pain to fix.
These are probably the most likely options you will have to work with—you may have a few others in the spectrum, feel free to let us know if you do!
Second Stop: Splinting Tips and Tricks
The biggest tip is to cut your pieces in advance! Do not wait until your patient is present to do this. It will save you time and make you appear more confident and knowledgeable. Lesson learned from me here, as I have fumbled around before. But no longer! I spend a bit of extra time getting my supplies together.
Practice! I’m guessing your supervisor won’t be opposed to you asking to practice a splint to further your skills. Make a few examples and then you will have a visual to refer to rather than just a picture.
Choose the best material for your skills—see the above section.
Use that splint crayon to mark where things should go on the forearm piece, where you should flare out a section, etc.
The beauty of splinting material is that it sticks to itself! Use this to your advantage and use smaller pieces to bond extra parts if you need.
Take your time and try to breathe!
Now for a few splinting examples to put in your toolbox…
Third Stop: Splinting examples and review! Here are a few options for neuro patients
The Scary: Finger Extension Outrigger, AKA Radial Nerve Extension Splint.
There are MANY pre-made options out there for this one, from fabric and velcro gloves that extend the fingers, to the SaeboFlex, which provides assisted extension for exercise. But you can make one. You can. I promise. I’ll outline two options that are not as difficult as they look!
Why would I use this? This is commonly used for wrist drop/radial nerve palsy. You can use it for neuro patients as well, as so many lack the MP or IP extension to release things from their affected hand.
A rather intimidating splint, there are so many parts to be attached; you may ask–“How do I do this??”
Here’s the good news: the metal components come in a kit and you can screw them together easily. You should have a large bar to go roughly over the MPs, some long posts, and a circular round piece that connects the MP bar to the posts that extend over each digit. The saddles and line are still connected to the forearm with rubberbands and a hook place on the forearm.
Several YouTube videos exist (including this quick one) for a “how-to” for this beast.
This can also be created via a quick and easy method without the outriggers, using only rubberbands to attach saddle to the forearm. Ask your resident CHT for a tutorial and you will be surprised how quick you can do this.
The Simple: MP blocking splint AKA “anti claw” Splint
Ever see someone attempt to grasp a small item and get hung up in an intrinsic minus position? If you could put a stop to that MP extension you may be able to place them in a more functional position so they can actually finish that 9 hole peg test you are attempting to administer!
And guess what? You can make this super easy with just one strip of material in a figure 8 pattern.
The Oldie: Cone Splint
This might be the most basic of “splints”. We’ve seen the pictures in our OT textbooks. By using a plastic cone that you most definitely have at your facility you can fabricate an easy-to-donn splint. If you have a patient that cannot get their hand into a resting hand splint safely or effectively this might be an “oldie but goodie” to revisit.
Of course, you are going to need a script to make any splint, and please use your clinical judgment to determine what is appropriate, but I hope now you can see three splints that may work well for your patients.
In the end, it pays to be prepared—cut your material in advance and be ready to go!
What else could you do with thermoplast? Get creative—probably more than you think!
If you’re already a splinting pro, what other splinting tips would you add to this article? What other ways do you use thermoplast? Please share in the comments!