Orfit Blog

Orthotic fabrication for kids

1 December, 2014 | Tags: , | Categorised in:

By: Debby Schwartz, OTD, OTR/L, CHT and Orfit Product Specialist

How do you get kids to cooperate with orthotic wear? How do you make sure the orthosis will stay put on their extremity? And how do you make an orthosis on a child that can’t sit still?

Orthotic fabrication for children can be quite challenging for all parties involved. Here are some guidelines to make the process easier for you and your young client.

When fabricating orthoses for young patients, you must always consider the age and developmental level of your client. The clinical setting in general may frighten younger children. Prepare a quiet area for splint fabrication without distractions and noise. Let them play quietly or eat a snack while you prepare the pattern and heat up the thermoplastic material. Always explain to the parents and caregivers what you are doing so they are calm as well.

Give a small piece of the activated thermoplastic material to the child and parents to handle while you fabricate the orthosis. Let them feel it and play with it. Make an orthosis on their doll or toy so that they have a buddy going through the same process!

Enlist the young client’s cooperation with the orthotic wearing schedule by using your knowledge of what appeals to each age group. Everyone is attracted to the bright colors now available in thermoplastic materials and strapping materials. Younger children might like their orthoses to resemble animals, so try giving the splint an actual face! Older teenagers might be tempted by cool bright colors that match their favorite teams or school colors. And everyone likes stickers or jewelry to liven up and individualize their orthosis!

Some additional strategies to increase compliance with orthotic wear are as follows:

  • Develop the schedule of orthotic wear with the child and family so everyone is well informed.
  • Provide written, verbal and pictorial instructions of the wearing schedule.
  • Create a chart and use stickers as a reward for following the schedule.
  • Label each orthosis clearly when issuing more than one, and make sure to show the child and caregivers how to don and doff each correctly. Numbering straps or color-coding an assortment of orthoses may be helpful.
  • Demonstrate the proper method of orthosis application to the child and family. Take a cell phone picture or a video of this so that there is a record!
  • Give the child a choice in color of materials and/or strappings so that they have a say in the design of the orthosis.
  • Allow the child to do a favorite activity while wearing the orthosis.

Increasing the likelihood that the younger child will not remove straps or the orthosis requires knowledge of child development and creativity! For very young children, use secure strapping that requires two hands to open, such as buckles, buttons, zippers, etc. Place these on the dorsal surface, which makes it difficult for the child to remove by himself. Some additional creative strapping solutions to keep orthoses on young patients are as follows:

  • Cover the orthosis with a shirt sleeve, stockinet sleeve or a tube sock/
  • Wrap an Ace bandage or Coban® wrap over the orthosis
  • Use shoelaces to tie the orthosis closed on the dorsal surface
  • Use devices typically manufactured for keeping shoelaces tied (Bow Biters).
  • All children grow quickly, so you must monitor the fit of the orthosis frequently.
  • Remember also that all children have unique hands that require custom designs and individualized intervention plans.

These guidelines can also be handy when treating patients with mental and/or physical disabilities.

More information on orthotic fabrication for kids can be found in the chapter “Orthoses for the Pediatric Population” in a soon- to- be released book on orthotic fabrication, entitled Introduction to Orthotics: A Clinical Reasoning & Problem-Solving Approach, 4th Edition. (Expected release date is December 10, 2014.)  The chapter is interspersed with multiple photos of orthoses for children, most of them fabricated using Orfit Industries’ low temperature thermoplastic materials!

Introduction to Orthotics is an excellent and practical resource for all occupational therapy practitioners and splint fabricators in clinical or educational settings. It features up-to date references, evidence-based research tables, orthotic patterns and how –to videos on orthotic fabrication. It is available for pre-order on popular websites like  www.amazon.com.

Here are some photos illustrating colorful orthoses for children, many fabricated with  Orfit Colors NS thermoplastic materials.  Orfit Colors NS is an elastic based thermoplastic material with excellent memory and stretch. This product comes in 8 brilliant colors and will appeal to everyone!  Two thicknesses (3.2 mm or 1/8” and 2.0 mm or 1/12”) and two perforation patterns help make this product incredibly versatile and appropriate for a wide range of pediatric orthoses.  In addition, Orfit Industries offers several orthotic designs in colorful precuts, making orthotic fabrication simple and easy.  And of course Orfit Industries has beautiful  strapping materials in multiple colors as well.”

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Report: MR in radiotherapy – an important step towards personalized treatment

20 November, 2014 | Tags: | Categorised in:

The Swedish Radiation Safety Authority has recently published a report regarding the use of MR scanning in radiation therapy. The report with the title ‘MR in radiotherapy – an important step towards personalized treatment?’ can be found  via this link (PDF).

The important role of imaging in radiation therapy is outlined in this document. The authors describe the use of MR scanning in radiation therapy together with the difficulties and possibilities. One of the topics is immobilization of a patient. Immobilizing a patient in an MR scanner can be challenging due to the size of the bore and the use of coils, especially for head and neck patients. “A common problem in in connection to RT is that patients need to be investigated in their treatment position in immobilization devices, which hampers the use of optimal MR-coil configurations.”

Immobilisation System MRI Siemens

Orfit Industries has developed an MR compatible immobilization device for the Siemens Magnetom MR scanners. This system allows to immobilize a head and neck patient in the same position on the CT, Linac and MR scanner with the same head support and thermoplastic mask. In addition it offers a solution to place the Flex coils closely to the head in order to have a good image quality. More information can be found on our website.

Immobilization devices for other MR scanners in the market are currently being developed.

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Choosing the Proper Splinting Material for your Orthoses

19 November, 2014 | Tags: , | Categorised in:

Answers to the most frequently-asked questions about our splinting materials

The following is a question and answer based article geared towards understanding the many different types of thermoplastic materials available for orthotic fabrication. It is important to understand the ways in which thermoplastic materials behave when activated in order to make them work properly and effectively for each and every orthotic design. Selecting the appropriate thermoplastic material may not be as clear cut as it seems, because there are so many choices available and so many slight nuances and differences among the products.

We hope this format will answer most of your questions about thermoplastic materials and help you select the best product for your patients’ needs.

1) “Why do we need so many choices in low temperature thermoplastic materials?”
“If you could choose just one splinting material to cover all your splinting needs in the clinic, which one would it be?”

We get asked these type of questions all of the time. We are fortunate to have so many choices in splinting materials today because one material will simply not cover all of our splinting needs. We make rigid and strong anti-spasticity orthoses, as well as lightweight thumb supports. We fabricate long arm orthoses with materials possessing maximum resistance to stretch. We also make dorsally based hand and finger orthoses from very conforming materials. There is no splinting material which will satisfy every requirement we have. So we need to understand the properties, characteristics, and qualities of these low temperature thermoplastic materials in order to make the best choices in our orthotic fabrication.

2) “What are Low Temperature Thermoplastic Materials (LTTPs)?”

The splinting materials we use to fabricate orthoses today are referred to as low temperature thermoplastics (LTTPs) because we activate them using relatively low heat (water between 60-70°C or 140°-170°F) as compared to other high temperature thermoplastics which require higher activation temperatures ( greater than 100°C or 210°F). We can also place these LTTPs directly on our patients while we are molding the orthoses, unlike the previous generations of therapists who used higher temperature products and had to create molds of their patient’s arms.

There are so many types and varieties of LTTP splinting materials available today.  It is just as important to know and understand the correct orthotic design for your patient’s needs as it is to select a proper LTTP for the orthosis. This ensures that your custom made fabricated orthosis is not only procedurally correct, but also supportive, durable, and comfortable as well.  Patients will tend to be more compliant with a comfortable and proper fitting orthosis.

3) “How did we get so many types of LTTPs?”

LTTPs became available in the 1960’s. The first LTTPs were made from rubber products and therapists working with these had good control of the material as they formed splints.  But the material itself had minimal stretch and very little conformability (see glossary in question 4). It was hard to mold around bony prominences. Plastic LTTPs were introduced in the 1970’s. Plastic LTTPs are highly conforming materials, but challenging to control. So, the manufacturers of these products tried combinations of plastic and rubber together. These LTTPs created well molded orthoses and offered a good amount of control.  Newer concepts in polymer production and design greatly improved the strength and rigidity as well as the elasticity of the LTTPs. As technology improves, we will continue to see improvements in our LTTPs.

4) “What are some of the basic characteristics of low temperature thermoplastic materials?” Continue reading

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Visit our new Educational Corner for Physical Rehabilitation

12 November, 2014 | Tags: , , | Categorised in:

The Orfit Industries website has a new Educational Corner where you can find instructions for fabricating static and dynamic hand splints. All splinting instruction videos can be found here as well. The basic principles shown on these pages can help therapists to make the right choice of splint for a given prescription.

You will find a description of the objectives and the possible indications for a splint. These are not binding but give a clear picture of what the purpose of the splint is.

We then suggest suitable splinting materials. This is followed by an illustration, which shows the most advantageous starting position. The pattern is drawn on a scale model based on the hand projection. Skin folds should be taken into account when copying the patterns to actual size.

The working technique described is the one we like to use at Orfit Industries. You may have your own preferred technique, which is perfectly feasible with any of the Orfit Industries splinting materials.

You can order a hardcopy of ‘The Splinting Guide’ with all this information from your local distributor.

We wish you a lot of “splinting” fun, and a rapid recovery to all your patients.

Educational Corner

Go to the Educational Corner >>

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Splint in the Spotlight (7): Dorsal Blocking Orthosis

5 November, 2014 | Tags: , , | Categorised in:

Splint-in-the-Spotlight

Each Wednesday, we feature our Splint in the Spotlight. With these articles, we offer you inspiration and
ideas for your future splinting projects and for the wide variety of pathologies you encounter with your clients.

Today we are focusing on the Dorsal Blocking Orthosis for management of post-operative flexor tendon and peripheral nerve rehabilitation. The Dorsal Blocking Orthosis is a dorsally placed immobilization orthosis designed to protect the sutured/repaired flexor tendons and/or nerves in a tension free position. Other names for this splint include Extension Block Splint, Dorsal shell, and Dorsal Protective splint.

Pathology:

Tendon lacerations are common injuries seen in the hand therapy clinic. Rehabilitation of these injuries can be challenging; complications include tendon ruptures and tendon adhesions. There are various post-operative rehabilitation protocols which are often selected based on the surgeon’s suturing technique or preference. Recent advancements in suture technique and style have allowed early active motion protocols and changes in orthotic design. The exact positioning of the wrist and metacarpo-phalangeal (MCP) joints in flexion may vary from protocol to protocol allowing wrist positioning in 0-45° of flexion and MCP joints in 60-90° flexion. Many therapists today follow a combination of different protocols, incorporating passive flexion of the finger joints, active extension of the fingers into the dorsal shell and allowing the fingers to rest in protected extension at night.

Regardless of the exact posturing, the dorsal blocking orthosis is a forearm based splint that prevents wrist extension, maintains the MCP joints in flexion, and the inter-phalangeal (IP) joints in extension.

This orthosis can be easily modified to the following:

  1. The synergistic orthosis with hinged wrist as outlined in the Indiana Flexor Tendon protocol;
  2. A hand based orthosis if only a digital nerve is repaired;
  3. If the wrist flexors are involved, but not the finger flexors, then the orthosis can be shortened to end at the PIP joint level dorsally.

Continue reading

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A Box of Splints

29 October, 2014 | Tags: | Categorised in:

By: Debby Schwartz, Orfit Product and Educational Specialist North America, Physical Rehabilitation

I recently donated a box of demonstration splints to the Occupational Therapy Assistant program at Daytona State University in Daytona Beach, FL. Shirish Lala, Academic Clinical Coordinator of the program and class instructor was delighted and wanted to incorporate these immobilization and mobilization splints into his class on orthotic fabrication. We collaborated together in order to conduct an online class using Adobe Connect so that the students and I could see each other in real time.  Students actively participated by describing each individual splint: what joints it immobilized, what motions it allowed and possible diagnoses that might benefit from wearing it. I offered commentary about the material characteristics and properties for each splint. For example: why some splints might require more rigid material (against increased tone), why some splints might require more conforming material  ( on the dorsum of the hand and over bony prominences) and why a specific splint might be made of a thicker or thinner material. The students nailed many of the possible diagnoses for resting hand splints, wrist thumb spica splints, wrist cockups- both volar and dorsal, elbow splints and others.

More challenging for them was figuring out what a selection of mobilization splints might accomplish. The students learned a little bit about the differences between dynamic, functional and static progressive orthoses through this process.

Towards the end of the class, I demonstrated two methods of orthotic fabrication for a thumb short opponens orthosis, using Orficast in 6 cm width as well as an Orfit Colors NS precut gauntlet thumb post splint. The students rated the experience as highly informative and enjoyed hearing from professionals in the field. This was an innovative and easy to manage format for classroom instruction and quite fun as well!

This is an opportunity that I would be happy to repeat to any interested groups of therapists and/or students.

Contact:

debby.Schwartz@orfit.com

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Splint in the Spotlight (6): “Stack” or “Mallet Finger” Orthosis

22 October, 2014 | Tags: , , , | Categorised in:

Splint-in-the-Spotlight

Each Wednesday, we feature our Splint in the Spotlight. With these articles, we offer you inspiration and
ideas for your future splinting projects and for the wide variety of pathologies you encounter with your clients.

Today, we focus on the “Stack” or “Mallet Finger” Orthosis.

Pathology:

A mallet finger develops when there has been disruption of the terminal slip extensor tendon to the digital phalanx (zone I), causing an inability to actively extend the distal interphalangeal joint (DIP).

The mechanism of injury can be sudden forceful flexion of the extended fingertip or blunt trauma to the dorsum of the finger. The injury can even result in a variable-sized bone avulsion from the distal phalanx or fracture through an open epiphysis.

How are mallet finger injuries classified (Doyle’s Classification of Mallet Finger Injuries)?

  • Type 1: closed rupture of tendon insertion
  • Type 2: Open injury with tendon laceration
  • Type 3: Open injury with deep abrasion with loss of skin, subcutaneous tissue and tendon substance
  • Type 4A: trans-epiphyseal plate fracture in children
  • Type 4B: avulsion fracture of the distal phalanx involving 20-30% of articular surface
  • Type 4C: fracture >50% with palmar subluxation of the distal phalanx

How are Mallet injuries treated in the clinic?  Continue reading

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Splint in the Spotlight (5): Finger Extension Assist Orthosis

15 October, 2014 | Tags: , , | Categorised in:

Splint-in-the-Spotlight

Each Wednesday, we feature our Splint in the Spotlight. With these articles, we offer you inspiration and
ideas for your future splinting projects and for the wide variety of pathologies you encounter with your clients.

Today, we focus on the Finger Extension Assist Orthosis.

Pathology:

When peripheral nerves are injured by compression or laceration, motor and sensory function can be significantly impaired. Nerve recovery may be prolonged and therapists are often confronted with the task of creating functional orthoses to help clients maintain their independence while awaiting nerve regeneration and/ or recovery. These functional orthoses can be challenging to fabricate, bulky with multiple attachments and unattractive.

Functional orthoses need to:

  • Be easy to don and doff;
  • Allow active motions of the non-involved muscles;
  • Apply force accurately to mobilize joints where the injured nerve no longer innervates the musculature;
  • Be acceptable and pleasing to the client.

Splint solution:

Orfit Industries has created a simple and aesthetic approach to functional orthoses for clients with peripheral nerve injuries.

The use of conveniently packaged pre-coiled wires which are easily attached to thermoplastic splints offers a creative and low profile solution for these complicated splints. Continue reading

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Splint in the Spotlight (4): Relative Motion Orthosis

8 October, 2014 | Tags: , , | Categorised in:

Splint-in-the-Spotlight

Each Wednesday, we feature our Splint in the Spotlight. With these articles, we offer you inspiration and
ideas for your future splinting projects and for the wide variety of pathologies you encounter with your clients.

Today, we focus on the Relative Motion Orthosis also known as the “Yoke” splint. This is a static splint designed to hold the affected digit in relative extension or flexion compared to the adjacent digits.

Pathology:

The relative motion splint is in the news these days, being touted as the “go-to-splint” for a wide variety of conditions affecting the hand and digits. At the recent ASHT meeting in Boston, a panel of experts debated the use of this simply designed splint for acute and chronic boutonniere, acute and chronic sagittal band rupture, digital joint stiffness, tendon injury and repair, nerve repair and other injuries.

The relative motion splint was initially designed for postoperative rehabilitation of extensor tendon injuries with the ICAM or “Immediate Active Controlled Motion” protocol. It was fabricated to be worn with a wrist cock up splint. It was designed to hold one or two digits in relative extension compared to the adjacent digits. It can also be used as an exercise aid to facilitate either flexion or extension of the affected digit depending on the position.

This orthosis is also being used in the management of sagittal band injuries and after repair of extensor tendon ruptures in rheumatoid arthritis. It is proving to be less bulky than other splints, more comfortable for the patient, and easily worn during activities of daily living.

The goals of a relative motion splint are to limit full flexion at the Metacarpal-phalangeal (MCP) joints and to facilitate increased motion at the more distal PIP and DIP joints.

The relative motion splint for extension holds the affected digit in about 15° of MCP joint extension in comparison to the adjacent digits and might be helpful with cases of MCP joint hyper flexion, limited flexor tendon excursion and IP joint stiffness. The relative motion splint for flexion holds the affected digit in about 15° of MCP joint flexion relative to the adjacent digits and is helpful when there is a PIP extension lag.

*A relative motion splint can often be fabricated circumferentially without the need for additional strapping.  Patients should be able to put on and take off their splints unaided.

Splint solution:

Many of Orfit Industries’ thermoplastic materials (1.6mm (1/16”) 2.0mm (1/12”) and/or 3.2mm (1/8”)) are suitable for the fabrication of the relative motion which requires very little preparation or pattern making. Simply cut a strip of material about 1 ½ times the width of all the digits. It should also be about the width of the proximal phalanx. If using very thin material, the material can be folded in half to give more support. Continue reading

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