Air splint in preprosthetic rehabilitation of lower extremity amputated limbs. A clinical report

The purpose of this paper is to discuss the merits of the air splint in the preprosthetic rehabilitation of lower extremity amputated limbs. We describe various methods to control postoperative edema and discuss the advantages and disadvantages of each. The protocol to apply and maintain the air splint and the advantages of this method over other methods are described. We believe the air splint is a very successful method available to all health care providers for safely controlling postoperative edema in a timely and effective manner.     

A novel splint for proximal interphalangeal joint contractures: a case report

Wollstein R, Rodgers J, Ogden T, Loeffler J, Pearlman J. A novel splint for proximal interphalangeal joint contractures: a case report. Proximal interphalangeal (PIP) joint contractures are notoriously difficult to treat. Best results are obtained with early mobilization and splinting, though a high level of adherence is critical for a good outcome. A new roll-on splint that aims to increase motion with minimal difficulty was used. The patient described here with moderate PIP joint contractures (30°-60°) was treated successfully using this splint. The splint design and therapy protocol are described. The patient was treated for 12 weeks with good adherence to therapy and splinting. Total active motion increased by 87% in the index finger and 108% in the ring finger. Grip, pinch, and tip-pinch strengths increased. The Disabilities of the Arm, Shoulder and Hand score improved from 26.7% to 2.5%. At 3 months, the patient returned to work. Though this case illustrates some of the advantages and disadvantages of the new splint, further study is necessary to evaluate the splint and compare it with other existing forms of treatment for PIP joint contractures.     

Rhizarthrosis and orthotic treatment. Review of literature]

OBJECTIVES: Trapeziometacarpal arthritis or rhizarthrosis is extremely frequent. Numerous treatments are available including drugs, physiotherapy, use of orthotic devices, surgery, etc. Few of these methods have been really evaluated. We propose a critical review of the literature on orthotic treatment in rhizarthrosis. MATERIALS AND METHODS: Review of the results of hand splint used in rhizarthrosis from eight studies published over the last ten years. RESULTS: Resting hand splints offer lasting and significant pain relief with a satisfactory compliance. They should be applied early in treatment and evaluated with regular follow-up. The drop-out rate is about 10%. Working hand splints, either alone or associated with a resting splint are also efficient. These is no modification in either the force or the ranges of motion. The functional benefit is satisfactory if the follow-up allows some tolerance and thus an optimal compliance. CONCLUSION: The major interest of the use of splinting is analgesia. The pain releif obtained with splint is similar when used alone or with a working hand splint. Working hand splint can improve hand function during vocational and avocational activities.     

Treating buckle fractures in children with removable splints

Buckle fractures of the distal radius are unique to children. Immobilising the limb in a plaster cast is the traditional treatment. An alternative is to use a removable wrist splint and this has been adopted at the author's clinic. In this article, literature on the change of practice is reviewed, the change is described and the outcomes evaluated. It was found that treatment with the wrist splint was cost-effective and was preferred by children, families and carers.     

A modified thumb spica splint for thumb injuries in the ED

There are a significant number of hand and upper extremity injuries treated in US emergency departments (EDs) each year. Many of these involve the thumb and wrist. These injuries encompass the range from fractures, strains, and sprains to more specific injuries such as gamekeeper thumb and de Quervain tenosynovitis. These injuries often require diagnosis, splinting, and referral to a hand or orthopedic surgeon. The splint described in this article is presently being used for patients with de Quervain tenosynovitis, but it may have more widespread application in emergency medicine. It is a safe and simple splint that is underused in EDs for splinting thumb injuries.     

The Kleinert modified dorsal finger splint for mallet finger fracture

Injuries to the hand and digits are commonly seen in the emergency department. Lacerations, contusions, puncture wounds, and fractures comprise the bulk of these injuries. A fracture to the dorsum of the distal phalanx can result in a mallet finger deformity. These fractures must be accurately diagnosed with the proper initial treatment begun. There is some disagreement over the best treatment approach and multiple different splints have been described in the literature. Conservative treatment with a finger splint is most commonly effective. We recommend a modified dorsal finger splint for these injuries. We describe a splint to properly treat the fracture, prevent complications, maximize patient comfort during rehabilitation, and prevent mallet finger deformity.     

Einfluss der Okklusion auf die plantare Druckverteilung beim Barfußlaufen

Objective

The aim of this pilot study was to analyze the effects of various dental occlusion positions on barefoot running behavior.

Material and methods

The six healthy subjects with a good endurance training status ran for 5 min at a speed of 10 km/h on a treadmill at each set of conditions. At the end of each set of measurement conditions the plantar pressure distribution was recorded. In addition to the resting position three different measurement conditions were recorded: the occlusion in centric condylar position (centric splint), myocentric position (DPS splint) and maximum intercuspidation.

Results

At the maximum length of the walking line of the right foot significant differences could be detected between the resting position and the maximum intercuspidation position, the centric splint and DPS splint and the DPS splint and the maximum intercuspidation position. The mean length of the walking line of the right foot showed significant differences between the resting position and maximum intercuspidation position, centric splint and DPS splint and DPS splint and intercuspidation position. The comparison between the DPS splint and the maximum intercuspidation splint was significant with respect to the maximum pressure in the left midfoot area.

Conclusion

In this pilot study barefoot running altered most while wearing the DPS splint and the maximum intercuspidation splint. These conditions showed in comparison to the resting position or the centric splint a lengthening/shortening of the walking line of the right foot and simultaneously a left-sided decrease/increase of the maximum pressure in the midfoot. As these parameters varied least while wearing the centric splint and at resting position, it was presumed that this splint is the best. A complete assessment of these trends is not yet possible due to the small number of subjects.     

Comparison of Muscle Activation while Performing Tasks Similar to Activities of Daily Livings with and without a Cock-up Splint

[Purpose] This study investigated changes in the activation of the main elbow muscle while performing tasks similar to activities of daily living (ADL) with and without a cock-up splint. [Methods] Sixteen participants performed a simulated feeding task and picked up light and heavy cans in the Jebsen-Taylor hand function test. The activation of the biceps brachii, the triceps brachii, and the brachioradialis with and without the cock-up splint was measured using a BTS FreeEMG 300 wireless electromyography system (BTS, Inc., Milan, Italy). [Results] The activation of the biceps brachii and the brachioradialis was significantly higher while performing the simulated feeding task with the cock-up splint than without the splint. While picking up the light and heavy cans, the activation of the brachioradialis was significantly decreased by wearing the cock-up splint. In the heavy cans task, the activation of the triceps brachii was significantly higher with the cock-up splint than without the splint. [Conclusion] This study showed that diverse muscles'' activation was increased or decreased when wearing the cock-up splint while performing tasks similar to ADL. The results of this study can be used as an educational resource for therapists teaching patients about splint application and splint compliance in ADL.Key words: Cock-up splint, Jebsen-Taylor hand function test, Muscle activation     

The Kerlix tongue-depressor splint for skin-grafted areas in burned children

A simple, sterile splint to ensure skin take and to immobilize joints in burned children who have grafted wounds is described. It consists of sterile tongue depressors placed 2 to 3 cm apart on the circumference of the limb and entwined at various layers with wrapped Kerlix. In our practice this device is advantageous because of its evaporative properties; it is lightweight and easily removed.     

Have you tried the sandwich splint? A method of preventing hand deformities in children

The prevention of contractures of the burned hand is an arduous problem in the young pediatric burn patient. Difficulty in applying splints, along with the time-consuming fabrication of complex splints, led to the development of the "sandwich" splint. This easily produced splint provides a means of preventing and treating hand deformities in this patient age group. Positive results have been noted with the use of this splint in conjunction with the patient's usual active physical therapy program.     

Brief or new: two pronation splints

For two years we have made pronation splints to assist quadriplegic patients who lack adequate forearm pronation but who have enough upper extremity strength to feed themselves and perform other self-care or functional activities. We have found the splints to be an appropriate alternative to the MAS. The first pronation splint fits underneath the arm, is simple in design and fabrication, and is hidden. However, occasionally the lever of the splint hangs up in the shirt, catches on the post of the wheelchair, or slips out from underneath the arm when the patient reaches away from the body. To eliminate these problems, we designed a second splint. But, this splint requires more time to make and adjust, has two parts to put on instead of one, and is more noticeable because it is worn on top of the arm rather than underneath it. When a patient uses either splint, the degree of pronation may be adjusted according to the activity by slightly rotating the splint either way when strapping it on. For example, full pronation may be required for feeding, but only half the range is necessary to operate the keyboard of a computer or typewriter. Once the Velcro straps are applied, the splints do not slip. The splints are not interchangeable from left to right and assistance is always needed to put them on. For patients with "weak" or "absent" wrist extensors, a wrist support and cuff splint may be used along with the pronation splint or a universal cuff, if wrist extension is adequate. The pronation splints are appropriate for those patients whose forearms supinate when they reach their hand to or near their mouth.     

Hypnotherapy in the treatment of the chronic nocturnal use of a dental splint prescribed for bruxism

A behavioral medicine case is described in which the patient was treated with a combined approach involving both hypnoanalytic and hypnobehavioral techniques. A 55-year-old man with bruxism was referred after 10 years of craniomandibular treatment because of his dependency on a dental splint prescribed for nocturnal use. A projective hypnoanalytic exploration helped to uncover and consequently resolve an earlier conflict that had been reactivated in the patient's work situation and which had become a constant source of mental and muscular tension. The hypnoanalytic exploration was followed by a cognitive-behavioral hypnotic intervention that was tape-recorded and prescribed for bedtime practice. Pre- and posttherapy psychological, physiological, and self-report measurements corroborated the patient's sense of well being that came with his newly found ability to sleep without the dental splint. The importance of considering multiple etiological factors in the treatment of such psychosomatic disorders as bruxism is discussed.     

Comparison of Task Performance,Hand Power,and Dexterity with and without a Cock-up Splint

[Purpose] The purpose of this study was to investigate the difference in task performance, grip and pinch strength, and dexterity with and without cock-up splints, which are widely used in occupational therapy practice. [Methods] Twenty-three participants performed Jebsen-Taylor hand function test and grooved pegboard for task performance and dexterity. The power grip and pinch strength was measured using Jamar hydraulic hand dynamometer and pinch gauge. [Results] In the result of the Jebsen-Taylor hand function test, task performance with the cock-up splint was slower compared to without the splint for all items. Men’s grip power with the cock-up splint was found to be significantly decreased compared to without the splint. Women’s grip and palmar pinch strength with the splint decreased significantly compared to without the splint. In the grooved pegboard test, the dexterity of both men and women with the cock-up splint decreased significantly compared to without the splint. [Conclusion] To assist patients to make wise decisions regarding the use of splints, occupational therapists must have empirical knowledge of the topic as well as an understanding of the theoretical, technical, and related research evidence. The results of this study will be useful in the analysis and understanding of changes in hand function in splint applications for people with hand dysfunction.Key words: Dexterity, Hand power, Splint     

Aortic rupture as a result of low velocity crush.

A case of aortic disruption in a 35 year old lorry driver is described. This occurred as a result of a low velocity crushing force. Clinicians should be aware that this mechanism of injury may result in aortic disruption as well as the more commonly mentioned severe deceleration force.     

三种牙周夹板治疗下前牙重度牙周炎：谁是首选材料？

背景：研究认为夹板固定可促进牙周组织修复和松动牙的预后改善。但夹板传力作用的大小,与夹板材料的刚度以及牙齿和夹板两者之间的密合程度有关系。目的：比较3种牙周夹板治疗下前牙重度牙周炎的疗效,找出最适合临床牙周夹板固定的材料。方法：将临床诊断为下前牙重度牙周炎的72例患者随机分为3组,每组24例,分别应用尼龙丝、正畸托槽和超强玻璃纤维3种牙周夹板对牙周炎患牙进行松牙固定治疗,并分别对3组患者治疗后1,6和12个月的临床疗效及各项牙周指数进行比较。结果与结论：玻璃纤维组牙周夹板固定后的1,6,12个月的临床有效率较高,分别是100%,100%和95.8%;尼龙丝组牙周夹板固定后6,12个月的菌斑指数、出血指数、牙周袋深度3项牙周指标最差,与正畸托槽组及玻璃纤维组比较差异有显著性意义（P 〈0.05）。结果表明应用玻璃纤维牙周夹板治疗重度牙周炎远期疗效显著,各项牙周指标恢复良好,临床上可以作为牙周炎松动牙固定的首选材料。     

Aortic rupture as a result of low velocity crush.

A case of aortic disruption in a 35 year old lorry driver is described. This occurred as a result of a low velocity crushing force. Clinicians should be aware that this mechanism of injury may result in aortic disruption as well as the more commonly mentioned severe deceleration force.     

The effect of wearing a wrist splint on shoulder kinematics during object manipulation

OBJECTIVES: To test the hypotheses that (1) wearing a flexible wrist splint while taking an object from a box increases known postural risk factors for shoulder disorders and (2) that the height of the front of the box modulates the effect on shoulder kinematics of wearing a wrist splint. DESIGN: A controlled laboratory experiment with 2 factors (splint wearing, box height). SETTING: Human performance laboratory. PARTICIPANTS: Ten consecutive healthy volunteers (5 men, 5 women; age range, 19-32 y). INTERVENTIONS: Experimental manipulation of wrist immobilization and box height. MAIN OUTCOME MEASURES: Humeral plane of elevation, humeral elevation, and humeral axial rotation. RESULTS: Wearing a wrist splint increased the maximum humeral elevation angle (P<.001), and the height of the barrier also increased the maximum humeral elevation angle (P<.001). The average difference in maximum humeral elevation between the splint and the no splint conditions was 6.8 degrees . CONCLUSIONS: Wearing a wrist splint while performing a job that requires removing objects from a box can increase risk factors for shoulder disorders. Workplace analysis should be performed to avoid secondary injuries before a patient wearing a wrist splint returns to work.     

New design of home-based dynamic hand splint for hemiplegic hands: a preliminary study

[Purpose] Hemiplegia following a stroke can affect hand movement; therefore, reconstructing hand function is the most desired outcome for stroke patients. The purpose of this study was to explore the application of rehabilitation through the use of a dynamic hand splint and observes its effects on the muscle strength and functional activity of the affected hands. [Subjects and Methods] Chronic stroke patients who underwent a 3-month conventional rehabilitation using the dynamic hand splint were recruited . Evaluations (e.g., electromyography, grip and finger strength appraisals, and Fugl-Meyer assessment) were conducted before the test, and after the 1 and 3 month’s intervention. The hemiplegic hands intermediately and after the treatment to assess improvement in hand-muscle strength and functional increase of the hand movements were evaluated. Patient response to use of the dynamic hand splint was assessed using a satisfaction scale after treatment. [Results] The results for maximal voluntary contraction of the extensor and flexor muscles and wrist and finger strength showed a statistically significant increase from the pretest to after 1 and 3 month’s intervention. [Conclusion] Wearing a dynamic hand splint for home-use as a supplementary training program in addition to hospital-based rehabilitation can effectively increase the muscle strength of hemiplegic hands.Key words: Stroke, Dynamic hand splint, Maximal voluntary contraction     

Factors that influence the duration of splint wear in peripheral nerve lesions

OBJECTIVE: To assess the weekly frequency and overall duration of wear for splints used to treat peripheral nerve lesions and factors that possibly influence splint wear. DESIGN: A total of 78 patients (23 women, 55 men) who had been treated with a hand splint for peripheral nerve palsy were interviewed by telephone, based on a preformulated questionnaire. The duration of wear, reasons for terminating use, the effect of the splint, the patients' assessment of splint treatment, the patients' instruction, and the patients' level of education were recorded. Survival analysis for the entire period of wear and logistic regressions to determine factors that influence splint wear were performed. Comparison of effect scores between lesions in the dominant those in the nondominant hand were carried out with a test. RESULTS: The median duration of wear was 6 mo for daytime and 4 mo for nighttime splints. Daytime splints were worn by 85% and nighttime splints by 84% of patients for 5-7 days per week. The reported effect of the splint was the only significant factor that influenced the frequency of wear. The splint was reported to be significantly more effective in the dominant hand than in the nondominant hand. Numerically, radial nerve lesions and cock-up wrist splints were most common. CONCLUSION: Regular splint wear was registered in the majority of patients and was positively influenced by a good effect of the splint, which was reported to be better in the dominant hand.