I wondered what would happen if I continued to do passive stretching and active hand exercises, but stopped wearing my resting splint at night. After a month of not wearing this splint I could feel my thumb getting tighter. I resumed wearing my splint and the next morning I woke up with a wicked ache in my thumb. My thumb is tight by bedtime so my splint has not eliminated spasticity. Placing the hand in one static position does not retrain the brain to produce active range of motion (AROM). Yet I believe my splint has prevented a painful permanent contracture.
Posts Tagged splint
What I Learned About Splints as a Stroke Survivor
1. Lannin N, Cusick A, McCluskey A, Herbert R. Effects of splinting on wrist contracture after stroke. Stroke. 2009;38:111-116.
Life is not fair to all of us. Sometimes our bodies betray us giving abnormalities. One such abnormality is foot drop. However, with science and medicine reaching its peaks, everyone can be helped.
It is now easier than ever to bring back normality into life using the gifts from technology. People whose life has been suffering because of foot drop can now have some normality back in life with AFOs.
It is essential to choose only the best AFO for foot drop that will have an impact on every movement of yours. To ensure the maximum amount of comfort, one must be careful while buying the best foot drop braces. Here is a list of things to memorize before you buy one.
- The best AFO for foot drop must be comfortable.
- It should be designed to support your foot firmly.
- The structure of the AFO should ensure that the weight of the body should be balanced on both feet properly.
- It ought to fit in your shoes properly to avoid discomfort.
- Most importantly, it must provide ease in movement.
Best AFO for Foot Drop
MARS Wellness Ankle Foot Orthosis Support – AFO – Drop Foot Support Splint Right, Medium
This product is specially designed keeping the foot anatomy in mind. Due to this, the AFO supports the foot perfectly well. The discomfort in the heel can be minimized as the foot is entirely balanced. This increases the stability and assists in walking steadily.
It has a thicker rare portion near surrounding the heel and a thinner footplate on the front which gives the heel more support. The front portion gets more comfortable as it gets softer.
The front portion can also be cut with scissors according to your comfort and desired size. This makes the product much convenient to wear and walk in.
The product is designed to fit in almost all kinds of shoes. So even with this condition, you can wear the shoes you like most. You can do that without being bothered by the AFO braces for foot drop.
To support the foot more conveniently, the AFO braces come with a hook and loop straps. You can tie these around the calf of your leg. This ties it securely to your foot as you walk. In our opinion, it is the best drop foot brace for people suffering this due to nerve palsy or heel cord tightness.
Ossur AFO Leaf Spring – Small/Medium – Right
Ossur offers a product of extraordinary strength. This product is designed to have a variable texture and width. This design gives the foot brace its strength, providing support and comfort.
It weighs much less than regular foot braces, making it much more comfortable to wear and convenient to walk in. However, even with a lesser weight the quality and strength are uncompromised. The stability it provides is ideal.
The product comes in varied sizes according to height. You can choose a brace according to your height which in turn makes it much more suitable to wear and use.
The footplate of this AFO brace for foot drop has viscosity. It supports the foot and is comfortable to wear. The footplate can be trimmed into the shape of your desire.
This brace has a hollow portion over the heels. Because of this, the product is the right one to use with a variety of shoes and is also brings you more comfort. This is the best AFO to use for long walks.
FREEDOM Swedish AFO, Black, Men’s Right
This product reduces the angle between your toes and the shin to a comfortable position. This reduces the effects of drop foot and makes it easier for you to walk in. It stabilizes the foot and brings in the sense of relaxation to the foot.
The product is made of injection molded polyethylene which makes it resilient. A strong enough AFO will provide the necessary support. The material used for the manufacturing of this foot brace makes it very durable.
The hook and lock strap that ties over the calf to fasten it is padded. This makes it soft and comfortable to wear. The splint can also be altered to an extent according to your desire by using a heat gun. So you can adjust your comfort level with the AFO.
Comfortland Foot Drop Splint (Large Left)
The flexibility and shape of the splint make it the best AFO for foot drop. This product will make life so much easier for you. Especially for people who have busy schedules and often need to wear shoes, this is the one for them.
The shape fits perfectly well in most shoes. Even if it doesn’t, all you need to do is trim it a little the way you want, and it will work just fine.
An elastic band secures the AFO with the leg. So if you happen to wear tight jeans, this won’t be bulging out to show you are wearing an AFO. The elastic band also makes it painless to wear.
The reinforcement to the foot is flawless with polyethylene structure. The quality and durability remain uncompromised.
Rolyan A508RL Large Ankle Foot Orthosis for Right Leg
This product can help people with a more severe problem of foot drop. It can hold up an unsteady ankle and provide support to the ankle and foot region, backed by the calf.
It is made of a hard material which can help with minor involuntary muscular contractions.
This contributes a lot of stability to the foot and assists in the regular walking, reducing the effects of the abnormality.
The foot plate is larger than the average size usually found in the markets. This provides aid to the forefoot during motion, keeping the foot steady. It can be modified slightly with the help of ordinary scissors or a heat gun.
BOLD Foot Drop Splint Left Small White
This product is excellent for people who develop the foot drop due to some neurological issues. It has better strength to provide for walking and can help in foot drop brace running.
This is usefectiveul in assisting with dorsiflexion and gives better control to the foot.
It is manufactured in a pre-dorsiflexion pose, which makes motion a lot more convenient. The comfortable straps that go around your calf to fasten it securely now come with padding.
So, this makes it easy to wear all day long without any inconveniences. Also, this can be used for rehabilitation purposes and offers some cure for foot drop.
Sky Medical Products (v) Semi-Solid Ankle Foot Orthosis Drop Foot Brace Medium Left
The shape of this product ensures a correction to the foot drop problem as you wear it. It assists in bringing your feet in a right posture, which in turn will help you carry out the daily life activities such as walking more easily.
This product will reduce the pain that may arise in the ankles and prevents calcaneus agitation. The heels are positioned in a convenient pose. It holds and supports the foot by reducing the angle of the foot. This angle is made abnormally large due to neurological issues which result in this condition.
The foot plate ends right before the toes to make their move easier and give more stability to you. The comfortable design of this AFO can aid the foot; it can be the foot drop brace for sleeping.
Since the design is convenient from the edges at the forefoot to the buckle strap at the leg, one can even sleep in this without much discomfort.
Frequently Asked Questions About The Best AFO For Foot Drop:
Q: What the best AFO for foot drop does?
A: It helps people with a condition of foot drop that comes due to neurological abnormalities. It stabilizes the foot and holds it in a healthy posture which makes it easy for a person to walk and stand correctly.
Q: Which is the best AFO for foot drop?
A: The best AFO will be the one which is comfortable to wear and provides the essential support to the foot. It also has a soft strap to avoid unease and blisters on the lower limbs.
Q: Does an AFO help in jogging?
A: If the foot drop is mild and the AFO is strong enough to support the foot and leg, then with time the person might be able to jog.
Q: Do AFOs cure foot drop?
A: They do not cure foot drop, but they can help in the therapy and make it easier to overcome mild foot drop.
By going through this list, one can decide which one is the best AFO for them. It is essential to choose thebest AFO for foot drop because it will affect all the things you do in routine. It aids in standing and walking correctly.
The best AFO is the one which goes best with the level of your case and brings most support and convenience. So, when choosing an AFO one must choose wisely.
[Abstract] Effect of task specific training and wrist-fingers extension splint on hand joints range of motion and function after stroke
Physical therapists should stay current on splinting for upper extremity injuries and conditions.
Custom fabricated thermoplastic splints have a multitude of applications in the rehabilitation of upper extremity injuries and conditions. Therapists need to be familiar with the many types of splints which can aid in a patient’s recovery and the proper way to document and classify each specific splint.
Rehab professionals are continually developing new and improved methods to use thermoplastic splints.
Static splints, such as a wrist cock-up splint following wrist fracture, can be used to immobilize and protect tendons, bones, ligaments, nerves and joints. This category of splints is generally used to safely position injured or compromised joints to avoid injury, stiffness or deformity. These splints can also be used to rest and properly position an overused, painful or inflamed area. Other examples of static splints include a wrist extension splint for lateral epicondylitis, a safe position splint used for a burn and a resting splint for a spastic hand from a cerebral vascular accident.
Thermoplastic splints, such as a proximal interpahalangeal joint flexion splint, may be used to mobilize stiff joints. This type of splint is designed to treat joint stiffness for a diagnosis such as a healed proximal phalanx fracture. These splints are commonly referred to as dynamic or static progressive splints.
Dynamic splints apply a constant, active force. A spring or elastic band, for example, is often used to stretch a desired structure. Unlike dynamic splints, static progressive splints use a non-elastic component to apply traction or torque to a joint at maximal end range.
Turnbuckles, which can be incrementally adjusted, are often used for static progressive splints. Use of these mobilization splints are based on the Low Load Prolonged Stretch (LLPS) theories in which a gradual tension of relatively low force is applied to a joint’s connective tissue for a prolonged time period to produce a desired effect of increased joint range of motion (ROM).
These splints allow the therapist or patient to precisely control the tension. The tension and the wearing schedule are both dictated and monitored by the therapist. The therapist should continually monitor proper positioning of the target joints to be mobilized and any adjacent joints.
Other splints, such as a radial nerve palsy splint, are designed to increase specific upper extremity functions. The radial nerve palsy splint facilitates functional grasp and maintains ROM by using dorsal outriggers, elastic bands and finger slings. This splint works to overcome loss of active wrist and metacarpal (MCP) extension while the radial nerve attempts to recover. The patient can actively flex the wrist and digits to functionally grasp an object as the splint’s elastic component performs the task of extending the wrist and MCP joints to allow the patient to release the object.
Torque Transmission Splints
A torque transmission splint can be used to facilitate or isolate the completion of a specific exercise. A distal interphalangeal joint (DIP) blocking/exercise splint, for example, is designed to facilitate isolated active flexion of the DIP following a healed tendon repair.
Splint Classification System
The specific description and classification of these splints should be obtained and documented by using the splint classification system, or more specifically, the Expanded ASHT Splint/Orthosis Classification System (ESCS). This description system accurately notes the exact type, location and purpose of the given splint.
The six criteria of the ESCS are as follows: 1. Articular vs Non-articular: “Articular” is automatically assumed, and therefore, specific documentation of the criterion is only needed if the splint is non-articular. (A humeral fracture brace is an example of a non-articular splint). 2. Anatomic Focus: What are the primary joints affected by the splint? 3. Kinematic direction: What is the position of the primary joint(s) of this splint? 4. Primary purpose: Is the splint fabricated to mobilize or immobilize, restrict motion, or transmit torque to another joint for exercise? 5. Type: How many secondary joints are included in the splint? 6. Total number of joints included: All joints that are affected by the orthosis are tallied here.
Many hand therapists may initially find this system confusing and somewhat challenging. In the past, therapists simply described the common but very general term for various splints. However, the ESCS system is the most effective way to describe what type of splint the therapist is fabricating and the overall purpose of the splint.
A wrist splint for lateral epicondylitis, for example, is essentially a wrist cock-up splint. If the splint is not documented using the ESCS, however, a colleague may not be informed of the most essential aspects of the splint. The therapist must know: Is the purpose to protect an injury to the wrist, to rest the tendons in the carpal tunnel, function as the base for some sort of dynamic/static progressive splint, or to be used as an exercise splint to transmit torque to the digits? In this particular splint, the purpose is to rest the long wrist extensors and decrease stress and tension on these muscle tendon units.
The ESCS would note this wrist splint as a “wrist extension immobilization orthosis type 0 (1).” This notation essentially encompasses the six criteria. Criterion one is left blank since we can assume the splint is articular. Criterion two is the wrist since this is the primary joint of focus for the splint. Criterion three is the position of wrist extension, since we are purposely placing the wrist in extension to rest the long wrist extensors. Criterion four is to immobilize since we are in fact immobilizing the wrist. Criterion five is zero because there are no secondary joints included in this splint. Criterion six is one because there is a total of one joint included in this splint.
If the fabricating therapist merely documents that they made a wrist cock-up splint, the colleague would not know essential data relating to the splint. Therapists should become familiar with the ESCS’ detailed explanation of the most appropriate manner to document and refer to specific types of splints.
Evolution of Splinting
Improvements in surgical techniques, more specifically suture and fixation techniques, along with an increased knowledge and understanding of how injured or repaired structures heal, have resulted in a constant evolution regarding the mobilization and subsequent splinting of injured areas.
Essentially, surgeons and therapists have found that many repaired structures are stronger than originally thought, and they can handle more stress earlier in the healing process. In the past, patients remained in casts for extended periods to allow for adequate healing and strength of repaired or injured structures to occur. This prolonged immobilization resulted in stiffness, scarring and/or adaptive shortening of tendon and ligament which became difficult, painful or impossible to overcome in the post-immobilization rehabilitation period, leaving the patient with a permanent ROM loss and subsequent functional deficit.
Surgeons and therapists have adopted early protective mobilization of repaired or immobilized structures with the use of custom splints rather than long extended immobilization in plaster or fiberglass casts. Modern fracture fixation techniques using rigid plates and screws, for example, allow a patient following wrist fracture to be transferred from a cast to a wrist splint in two to three weeks in some cases, rather than six to eight weeks in a cast. A removable wrist splint can be beneficial to allow early protective/gentle ROM.
Communication between surgeons and therapists is essential to determine the appropriate timeframe for splinting based on the strength of repair or fixation and stability of the injured area for each specific patient case. For the compliant patient, this can result in increased ROM, decreased scarring, post-operative pain and stiffness and a better overall functional outcome. Early protective ROM is monitored closely by the therapist to avoid any motion that may disrupt the fixation or repair.
New suture techniques and materials, along with a better understanding of how tendons heal along with the increased knowledge of the tensile strength of repaired tendon has also changed the way therapists and surgeons treat post-operative tendon repairs in the hand. Following repair of a flexor or extensor tendon in the hand, a custom splint can be fabricated to allow for early protective ROM. The custom splint can position the wrist and hand in a manner that safely allows gentle glide of the repaired tendon. This approach reduces or prevents scar tissue from becoming established on the tendon and surrounding tissue/bone.
Proper positioning of the hand and wrist in the protective splint is critical because scar tissue formation on newly repaired tendons can significantly inhibit ROM and subsequent hand function. Gently gliding the tendon as soon as the repair can handle some stress can greatly decrease the scar tissue from binding to the tendon. In some cases, a tendon repair can be passively mobilized in a controlled, supervised manner as soon as 1.5 to 2 weeks post-operatively.
There is continued discussion and debate about how soon a tendon can be mobilized both passively and actively within a protected early ROM protocol. New and progressive protocols show evidence that a repaired tendon can be actively mobilized as soon as two weeks. Not all surgical patients are appropriate candidates for the early mobilization and splinting protocol. The patient must have a solid understanding of the rehab protocol and demonstrate good compliance with the protective ROM program. Children and patients with decreased cognition, for example, are generally poor candidates for these early ROM protocols.
If a patient deviates, even slightly, from the prescribed exercise protocol, rupture or gaping of the repair can result, causing disruption or failure of the surgical procedure. As the tendon repair gains strength, the splint can be modified and eventually discharged to allow increased and gradual unrestricted ROM and subsequent strengthening of the repaired tendon.
Custom splinting has and will continue to evolve as clinicians learn new and improved methods for using splints to best serve our patients. New types, modifications and variations of splints are continually being developed. All therapists practicing in a setting where patients can benefit from custom splints should be aware of these developments and incorporate them into their own treatments.
Brian Knutsen is president of Buzzards Bay Hand Therapy LLC, located in Marion and Lexington, MA.