" Simple Splints " THE JOURNAL OF
REHABILITATION IN ASIA, APRIL 1988.
Presented paper at XV National Conference of Indian Association of Physical Medicine & Rehabilitation Held At Madras, JAN. 1987.
Published : The Journal of Rehabilitation in Asia, April’1988
INTRODUCTION
The concept of splints in the management of polio or any other condition is not new. But high rejection rate is reported. Contraptions keeping in mind the patient’s need and comfort, many reduce rejection rate. The were designed only on the basis of clinical experience and problems faced while treating such patients and not on the principles of orthotics. The main aim of the simple technique is to prepare these splints from commonly available material at minimum cost.
NIGHT SPLINTS:
Night splints are ‘L’ shaped splints routinely used to keep lower limbs in desired position in polio. These conventional ‘L’ shaped splints were applied either too loose or too tight. So additional of sponge with cotton or rexine cover as cushion for the comfort of the patient and cotton belts with buckles for the convenience of the person who applies the splint were added. But one more problem of maintaining correct position of lower limbs after splinting remained, as just ‘L shaped splints had tendency to rotate externally or abduct at hips-particularly during sleep. So, ‘Locking’ of splints was essential. A part from positioning, the can be safely used in recovery period of polio on standing. A part from this, these can be used to develop standing balance in mild cases of ataxia, cerebral palsy with minimal eqtinous.
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Method and Materials Required: For a pair of Night Splints |
Approx Cost |
1 |
Plywood 8 to 9 mm thickness, 5 to 8 cms width, length measured from gluteal fold to heel and second piece from heel to tip of greater toe to cover foot |
4.00 |
2 |
‘L’ shaped angles 2 pairs |
3.00 |
3 |
Buckles (10) |
4.00 |
4 |
Nails, screws and nut bolts of appropriate size |
2.00 |
5 |
Rexine ( or cotton covering) |
4.00 |
6 |
Adhesive |
3.00 |
7 |
Needle and thread |
1.00 |
8 |
Foam (sponge) 8mm |
2.00 |
9 |
Cotton belt (1.5 meters) |
4.00 |
|
Labour Charges |
8.00 |
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|
|
35.00 |
The cost just Rs 35/- for a pair of Night Splints can be reduced further, if these are prepared in large numbers. Fine cotton belts of a appropriate length are fixed with the help of nails on the other side as shown in figure No 1. foam (sponge) is kept on inner aspect and is fixed and covered with rexine or cotton, as desired. It is better to avoid sponge for 2.5cms, at distalend to accommodate heel. If rexine is used a thin cotton clothing is used while applying the splint so as to avoid prolonged contact with rexine. Thickness of the splint gives minimal flexion of the hip which is ideal position at hip without any external rotation or abduction. Usually, flexion at knee joint is avoided as in acute or recovery period child is very much prone to develop contracture very fast if same position is maintained for prolonged period. If it is desired to have a slight flexion at knee, it can be achieved by placing a cotton roll under the knee while applying splint.
These splints are usually applied to both lower limbs, even when only one lower limbs is paralysed, so as to maintain desired position in acute period and splints on both sides help in recovery stage for standing balance. It has been observed that whenever only one splint is used, difficulty arises while making the child to stand on the standing board. So it is advisable to use splints on both lower limbs at least in the beginning.
KNEE SPLINT:
It was observed that while treating fresh cases of paralytic polio the children had a tendency to develop Genu-recurvatum. Usually, anxious parents make their child stand or walk as early as possible without any external support and this EARLY support less weight bearing is the most common preventable factor causing Genu-recurvatum.
All children with possibilities of developing deformity should be encouraged to weak splints until full recovery or they have atleast completed their growth period, even if they can walk without support. Posterior or anterior slab splint, above knee caliper and Swedish knee cage were tried but results were not satisfactory. Simple posterior or anterior slab splint, used for Genu-recurvatum no doubt corrects the deformity at low coast, and allows early weight bearing but with such splint there are “No Movements” at knee joint which is the main disadvantage.
Even though, above knee caliper is on of the ideal caliper for Genu-recurvatum, its cost, no availability in smaller places, and above all its poor acceptance by children as well as their parents are factors to be considered.
An indigenously made rational splint should:
- allow normal flexion and extension at knee joint but not hyper-extension
- allow early weight bearing of the affected limb
- not interfere with recovery
- not require too frequent alterations
- be available easily
- be economical
- be of light weight and acceptable
- be simple and easy to use
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Materials and Methods to prepare V. V. F. K. S |
Approx Cost |
1 |
Plywood 8 to 9 mm thick, two rectangular pieces, width correspond to width at popliteal crease (about 5 to 8 cms) upper rectangular piece covering posterior aspect of thigh measured from popliteal crease to gluteal fold and lower one covering posterior aspect of leg from popliteal crease downward covering ¾ of the leg |
2.00 |
2 |
Metallic hinge of appropriate size |
0.75 |
3 |
Four screws of appropriate size |
0.75 |
4 |
Cotton belts (pediatric size) 4 with buckles |
4.50 |
5 |
Adhesive plaster |
3.00 |
6 |
Foam (sponge or cotton pads) |
1.00 |
7 |
Nails (8) of appropriate size |
0.50 |
8 |
Labour charges |
4.50 |
|
|
|
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17.00 |
This splint is in clinical use since 1982 with good acceptance rate. It is very important to understand that this splint is not the ‘CURE’ for Genu-recurvatum, it is only for prevention.
Two plywood pieces are assembled with hinge and screws. Belts are fixed on the side of hinge, two on either side, one at distal and one close to the hinge. Cotton pads / sponge is placed on the other side with the help of adhesive plaster. However, it can be made more attractive using foam and rexine for those who can afford it but basic principle and structure remains the same.
APPLICATION OF THE KNEE SPLINT:
The knee splint is applied over posterior aspect of the leg with hinge at the level of popliteal crease. It should be neither tight nor loose. Passive flexion and extension should be ascertained before making the child stand. Splint can be discarded after full recovery or when there is not possibility of developing Genu-recurvatum. Usually it takes about 3-6months in fresh cases of paralytic polio.
PRESSURE SPLINTS: (AIR PILLOW SPLINTS)
Pressure splint (pneumatic) were designed as an emergency splint for first aid and safe transport of fractured, crushed or sprained limbs. Subsequently, Margaret Johnstone introduced these splints for the management of spasticity in hemiplegia. Dr E G WALSH, then Medical Director of Parke-Davis and team of researchers from Edinburgh University, Physiology department conducted research study and produced objective evidence necessary to support the use of “Pressure Splint” in the treatment of hemiplegic are. Pressure Splints are freely available in Western Countries and unfortunately then are unheard of in our country.
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Air pillow which is commonly available all over the country can be converted into pressure splint, by folding pillow on itself, and stitching its two borders carefully, and not puncturing its pneumatic area. It costs just Rs 27/- per pillow (now converted into splint) and is about 10times cheaper than pressure splint which available in Western Countries.
APPLICATION OF THE SPLINT.
The pressure splint is applied with shoulder in external rotation, with elbow, wrist and fingers in extension and thumb in abduction i.e. recovery pattern. It is inflated with mouth only and not by any mechanical pump, as air from lungs are warmer and will not cause any harmful construction. It is kept for about 30-45min and then removed. It shoulder be applied several times a day and parents should be taught how to apply I correctly.
Pressure splints are used in many therapeutic exercises for hemiplegic arm and few are show in figures No 4 and 5.
Pressure Splints are used to:
- maintain the Anti-Spasm or recovery pattern
- boost sensory input to stimulate the spinal reflex are
- give the stability of sustained posture necessary for rehabilitation
- control associated reactions
- stabilize joints for early weight bearing
CONCLUSION:
An attempt is made to simplify and design new splints from commonly available material to get better results, thus preventing deformities and helping rehabilitation.
Family physician should be involved in rehabilitation programmes and he can contribute in better under-standing between practical problems and rehabilitation programme giving better follow-up and results.
Reference:
Margaret Johnstone – Restoration of Motor Function in the stroke patient. Second Edition 1983, Churchill Livingstone.
Acknowledgements:
I am thankful to my wife Mrs Meena Varma for help and encouragement for making this ventures successful.
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