Orthotic fabrication can play a crucial role in the treatment of congenital malformations to the upper extremities.
In general, specific hand anomalies need early expert care to correct and/or prevent deformities, and allow for the development of independent hand function. Therapists play an important role in the evaluation and treatment, before, during and after, any surgical interventions that may be necessary.
Let’s have a look at the characteristics of pediatric splinting for congenital malformations.
In this blog post we’ll be covering:
Common congenital hand anomalies
Goals of orthotic fabrication for congenital malformations
Orthotic fabrication: differences between children and adults
Suitable splinting materials
Patient follow-up: how & what?
Tips for a more enjoyable fabrication process
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Some of the more common congenital hand anomalies are:
Orthotic interventions can provide a lot of benefits for these conditions.
On the one hand, orthoses can stretch the joints/soft tissue before surgery or protect the limbs after a surgical intervention. On the other hand, they can help prevent further deformity as well as enhance the child’s upper extremity function and skill development.
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The goals of orthoses may include:
Orthoses can be fabricated for individual joints such as the elbow, forearm, wrist, hand, thumb and digits. Or they can include multiple joints.
Sometimes, a patient with multiple joint involvements may require a variety of orthoses. In that case, it will be helpful to use a creative schedule that allows for wearing each one at specific times.
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Orthotic fabrication for a child will be different than for an adult:
Resting orthosis.
Examples of orthoses include a dorsal wrist cock-up for a child with Cerebral Palsy, a web spacer for a child with Thumb Hypoplasia, or a circumferential wrist support for a child with Arthrogryposis.
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When choosing a material for a child’s orthosis, incorporate the following elements:
Orfit Colors NS in 2.0 mm (1/12” ) comes in 9 bright colors, designed to appeal to everyone. Let each child pick their favorite color which may help to increase compliance with orthotic wear. You can also decorate with scraps of other colored materials.
Orfilight, Orfilight Atomic Blue NS, and Orfilight Black NS are lightweight materials, excellent for any body part. You can use them to create lightweight orthoses for small infants and toddlers. They are especially suitable for children with joint inflammation due to Juvenile Rheumatoid Arthritis or after surgeries involving the thumb (Hypoplasia) and fingers (Syndactyly release, Camptodactyly).
Orficast and Orficast More are ideal materials for the fabrication of small and larger orthoses for children. Due to the rapid setting time, a good fitting orthosis can be made in a minimum of time. The breathability of the textile-like structure allows for good transportation of sweat and moisture, thus preserving skin quality and worry-free wearing during play and physical activities.
Tip! Think about combining different materials in one orthosis. For example, combining the breathability of Orficast for a general circumferential wrist orthosis with a piece of Orfit Colors NS for increased stability.
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The below tips can help you in the follow-up of your patient:
Clubhand after centralization.
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Here’s how you can make the orthotic fabrication process more enjoyable for your patient:
Orthosis to prevent scar flex contracture after removal syndactyly.
The images in this blog post were provided by Anna Ovsyannikova.
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Written by Debby Schwartz, OTD, OTR/L, CHT
Physical Rehabilitation Product and Educational Specialist at Orfit Industries America.
Debby is a certified hand therapist with over 36 years of clinical experience. She completed her Doctorate of Occupational Therapy at Rocky Mountain University of Health Professions in 2010. She has worked at Orfit Industries America as Product and Educational Specialist since 2007.
Debby is also an adjunct professor at the Occupational Therapy Department of Touro University, School of Health Sciences, and at the Occupational Therapy Department at Yeshiva University, Katz School of Science and Health in NYC. She has written many book chapters in the field of hand therapy and multiple articles for hand therapy journals, including the ASHT Times and the Journal of Hand Therapy. She has published a new textbook on orthotic fabrication together with Dr. Katherine Schofield, entitled “Orthotic Design and Fabrication for the Upper Extremity: A Practical Guide”.
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