Interesting skills

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Yesterday I had an all-day skills workshop, to learn about the occupational therapy specialisation of hand therapy. This basically meant learning how to make splints. The finished lot of splints we had to make is shown in the photo above. There are two resting splints (blue) because I was the “sim-pat” (simulated patient) for the whole class demo for that one as well as having one made for me by my partner. We were paired up and each of the pair took it in turns to be the model/patient and the therapist.

The splints in the photo above were made by using a heat pan  to soften various materials in order to mould them to my shape, based on patterns provided.

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Heat pan

The splints we made were as follows:

  1. The “Figure 8” finger-splint
  2. The Mallet finger-splint
  3.  Hand splint*
  4. Wrist cockup splint
  5. Functional resting wrist/arm POSI splint (pan design)*

(*Not exactly its technical name, but the approximation my memory’s giving me. :/ )

The Figure-8:

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This sort of splint is used in two ways:

  • either as shown here, preventing hyperextension (over-straightening) of the middle knuckle of the finger (technical name: proximal interphalangeal joint [PIPJ]);
  • or flipped, so that the cross-over part of the pattern is on top, to prevent flexion (bending) of the middle knuckle (PIPJ)

The material is a thin piece of “aquaplast” a type of heat-modifiable plastic. We placed the strips into the heat pan, then waited until they had turned clear. We then lifted them out of the pan onto a tea towel nearby, quickly pressed them flat (and peeled them off the tea towel if they stuck), then moulded it to the sim-pat’s finger.

The sim-pat, our partner, was holding their hand in a loose circle, with the middle knuckle (PIPJ) slightly curled inwards (flexed). We started behind the knuckle, wrapping the middle of the strip across the sim-pat’s finger then crossed the two sides over underneath the knuckle. We then brought the sides up so that they met on top of the finger again. This involved a bit of fiddling around due to the way the sides met up. Had to make sure it wasn’t too loose or too tight.

While wearing it, you should still be able to make a fist (if using it with the crossover underneath the knuckle) or if using it with crossover on top, still be able to flex (bend) the main knuckle (metacarpo-phalangeal joint, MCPJ) and the smallest finger knuckle (distal interphalangeal joint, DIPJ).

The Mallet:

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This one is useful for:

  • Preventing the smallest knuckle (DIPJ) from hyperextending (over-straightening)
  • Window for fingernail preferred but can be absent if required
    • Need to be able to fully bend the middle knuckle (PIPJ) while wearing it.

We scratched out/drew a design on a flat piece of aquaplast based on a tracing of the sim-at’s finger. We then cut it out and put it in the hot water to soften. Afterwards we wrapped it around the sim-pat’s finger, ensuring that it was a snug fit without being too tight.

Hand splint/ safe position splint:

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This one is useful if you have:

  • Burns
  • Acute traumatic hand injury

Safe position refers to POSI = Position of Safe Immobilisation. It’s the position that is safest for immobilising a joint and has to do with angles, preventing further injury to the joint and preventing injuries to joints/tissues around the injured joint due to overcompensation.

We cut out the pattern after tracing around the person’s hand, using landmarks like the wrist, the bottom thumb joint (carpometacarpal joint, CMCJ) and thumb knuckle (MCPJ).

Wrist cockup splint:

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Useful for:

  • Managing arthritis
  • Wrist pain or weak wrist
  • Weakness in wrist extensors
  • Post wrist fractures

Again, we traced out a design around the person’s hand (and arm), using particular points like the borders of the wrist, the bottom thumb joint (CMCJ) and the thumb knuckle (metacarpophalangeal joint, MCPJ) Then we put it in the water to soften before cutting through the material and moulding it to the skin.

It should extend two-thirds of the way down the forearm and leave the fingers and thumb free.

Things to be aware of include:

  • Watching out for bony landmarks etc. and remoulding if necessary to avoid them so that the splint does not rub and create pressure points/sores. Applicable to all splints, but noted for this one because I’ve discovered since taking mine home that there’s a pressure point on mine!
  • Should be able to still form a fist.

We used tailorsplint to make this and I understand why the workshop facilitator loves it so much. It was easily the most pliable and flexible of the materials we used with a decent “working time” aka amount of time you can work with it in one setting before it hardens. This does mean that supports like bandages or a second pair of hands are useful when moulding it – but the second pair of hands cannot come from the patient, they must stay still! (Sounds obvious, but people will still try, because you want to help…)

Functional resting wrist POSI splint:

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Useful for support when wrist is affected by:

  • Arthritis
  • Neurological condition (e.g. stroke)
  • Comatose patient

We used a material called “ezeform” to make this. It was the firmest material and was a bit of a nuisance to work with because you had to soften it to cut it, but once cut the pieces would start to stick together. Also didn’t help that as this was the longest splint, you needed a lot of working space.

Landmarks used for tracing were the mark of two-thirds down the arm, the wrist, the bottom thumb joint and thumb knuckles as well as palmar creases. Due to the way this splint had to be cut, you needed to mark the inside point near the main thumb knuckle, allow another centimetre inwards then draw a “u-shape” down to the bottom thumb/hand joint (CMCJ) and up to meet the outer line of the tracing around the hand. This created the flap that my thumb curves around in the picture.

I have it on good authority that this one is comfortable, as it should be. Not only did it feel comfortable to wear personally, but when I showed it to a few friends they thought it was comfy too.

 

It was an interesting day, but I don’t think I want to make a career out of doing hand therapy (like our facilitator does). It’s a bit too fiddly for me.

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