838 An Economical Alternative to Static Progressive Splinting of the Elbow

Abstract

Abstract Introduction A common musculoskeletal complication of burn trauma are elbow extension contractures which can have disabling effects on both daily living skills and leisure activities. One intervention which is used by Therapists to maximize active range of motion in these cases are static progressive splints. The benefit of static progressive is providing a continued gentle stretch, which is adjustable, to maximize length of connective tissues and improve joint pliability. These types of splint can be custom made or purchased commercially to the cost of the patient. Commercially provided static progressive splint are costly for the patient and are not efficient in capturing end range extension. Traditional static progressive splint patterns do not allow for the patient to provide the adjustable force rather, the therapist remodels the splint as range of motion gains are achieved. The “I” splint was created to allow for the patient to provide a static progressive low load adjustable force and range of motion while using the splint over the course of thirty minutes. Methods The splint is fabricated from therma plastic material. The standard anterior elbow extension splint pattern is made thought with a midline window. (Photo 1). When modeling the splint, the therapist positions the boarders of the splint higher than the upper extremity as this will act as the level arm for the adjustable force. Three straps are attached (photo 2). Distal at the wrist, proximal at the elbow and midline at the elbow. The elbow strap attached to the medial board, cups the posterior elbow and is fed inside the lateral board, then pulled up and over th boarder. This positioning transmits the upward force to gain extension. As the stretch decreases, the strap is pulled more tightly, allowing for increased elbow extension. The elbow comes up and through the window. Goal is for the patient to use 3 times per day for 30 minutes each session followed by exercise or functional activities which engage improved connective tissue length. Results There are many benefits from the use of the “I” splint pattern. The splint is able to be fabricated during 1 therapy session and be used immediately. The therapist only bills one orthotic charge and splint charge vs a costly rental and purchase price for the patient. The window design allows for greater adjustability of force able to capture fluctuations with stiffness and pain without fabricating another splint. The splint is lighter weight and easily portable. Conclusions The “I” splint design is a effective, efficient and economic intervention to treat elbow extension contractures. Applicability of Research to Practice Further research needs to be done to investigate range of motion gains and time to makes gains, effects on functional outcomes, cost benefits analysis with the “I” splint design for the patient and Health Care Systems.