Splint Wear Research Articles

What are the barriers to upper limb splint adherence, and how is adherence measured? A systematic review.

Non-adherence to splint wearing following an upper limb traumatic injury is a significant medical issue. Optimal outcome following such injuries relies on people adhering to the prescribed splint, and a failure to do so can negatively impact outcome and increase healthcare burden and costs. This systematic review aims to compare and synthesise the evidence related to measuring adherence to wear recommendations and the barriers to splint wearing following upper limb trauma in adults. Databases (EBSCO, PubMed, EMBASE and Science Direct) were systematically searched for articles that met the pre-agreed eligibility criteria between February and May 2023. Data on study characteristics and reported outcomes relating to measuring and quantifying splint adherence and barriers to adherence were extracted. A total of 16 articles were included for final review. Several methods were used to measure adherence, with no single tool used predominantly. These included patient or therapist reported data, preexisting classification systems and an electronic device. Methods used to quantify adherence was also heterogenous in nature, and a range of investigator and patient reported barriers to splint wearing were reported. This review demonstrates heterogeneity in both classifying and measuring splint adherence, as well as in the barriers to splint wearing reported. Moving forward, using agreed measurement and reporting practices for splint adherence will enable researchers to complete high quality trials to determine splinting outcomes, and may ultimately enable health care professionals to improve adherence and, subsequently, outcomes in clinical practice.

Flexor Injury Rehabilitation Splint Trial (FIRST): protocol for a pragmatic randomised controlled trial comparing three splints for finger flexor tendon repairs

BackgroundWithout surgical repair, flexor tendon injuries do not heal and patients’ ability to bend fingers and grip objects is impaired. However, flexor tendon repair surgery also requires optimal rehabilitation. There are currently three custom-made splints used in the rehabilitation of zone I/II flexor tendon repairs, each with different assumed harm/benefit profiles: the dorsal forearm and hand-based splint (long), the Manchester short splint (short), and the relative motion flexion splint (mini). There is, however, no robust evidence as to which splint, if any, is most clinical or cost effective. The Flexor Injury Rehabilitation Splint Trial (FIRST) was designed to address this evidence gap.MethodsFIRST is a parallel group, superiority, analyst-blind, multi-centre, individual participant-randomised controlled trial. Participants will be assigned 1:1:1 to receive either the long, short, or mini splint. We aim to recruit 429 participants undergoing rehabilitation following zone I/II flexor tendon repair surgery. Potential participants will initially be identified prior to surgery, in NHS hand clinics across the UK, and consented and randomised at their splint fitting appointment post-surgery. The primary outcome will be the mean post-randomisation score on the patient-reported wrist and hand evaluation measure (PRWHE), assessed at 6, 12, 26, and 52 weeks post randomisation. Secondary outcome measures include blinded grip strength and active range of movement (AROM) assessments, adverse events, adherence to the splinting protocol (measured via temperature sensors inserted into the splints), quality of life assessment, and further patient-reported outcomes. An economic evaluation will assess the cost-effectiveness of each splint, and a qualitative sub-study will evaluate participants’ preferences for, and experiences of wearing, the splints. Furthermore, a mediation analysis will determine the relationship between patient preferences, splint adherence, and splint effectiveness.DiscussionFIRST will compare the three splints with respect to clinical efficacy, complications, quality of life and cost-effectiveness. FIRST is a pragmatic trial which will recruit from 26 NHS sites to allow findings to be generalisable to current clinical practice in the UK. It will also provide significant insights into patient experiences of splint wear and how adherence to splinting may impact outcomes.Trial registrationISRCTN: 10236011

Validation of Temperature Sensors to Monitor Thermoplastic Splint Wear in Hand Surgery Patients.

The aim of this study was to validate the use of temperature sensors to accurately measure thermoplastic volar forearm splint wear in a healthy cohort of volunteers using 5- and 15-minute temperature measurement intervals. A prospective diagnostic study was performed to evaluate the diagnostic accuracy of temperature sensors in monitoring splint wear in 8 healthy volunteers between December 2022 and June 2023. Temperature sensors were molded into thermoplastic volar forearm splints. Volunteers who were familiar with the study aims were asked to keep an exact log of the time spent wearing the splint ("actual wear time"). Sensors recorded temperatures every 5 or 15 minutes, and separate algorithms were developed to determine the sensor-detected wear time compared with the actual wear time as the gold standard. The algorithms were then externally validated with the total population. The 5-minute and 15-minute algorithms demonstrated excellent sensitivity (99.1% vs 96.6%), specificity (99.9% vs 99.9%), positive (99.4% vs 99.5%) and negative (99.9% vs 99.3%) predictive value, and diagnostic accuracy (99.8% vs 99.3%), respectively. The 5-minute algorithm recorded 99.5% of the total splint hours, whereas the 15-minute algorithm recorded 96.1%. There was no significant difference between the actual time per wear session (5.4 ± 2.7 hours) and the time estimated by the 5-minute algorithm (5.4 ± 2.6 hours; P = .40), but there was a significant difference for the 15-minute algorithm (5.2 ± 2.6 hours; P < .001). Temperature sensors can be used to accurately monitor thermoplastic volar forearm splint wear. Diagnostic II.

564 Simplified Dynamic Splints for Common Scar Contractures of the Hand

Abstract Introduction Common problems associated with immature burn scarring of the hands include proximal interphalangeal (PIP)/distal interphalangeal (DIP) flexion contracture, first webspace contracture, and metacarpal phalangeal (MCP) hyperextension that require diligent splinting intervention in therapy and at home to improve patient outcomes. Dynamic splinting can be used to provide low-load long-duration stretch; however, they can be difficult for patients to don independently at home and are often time consuming for therapists to fabricate. Alternative methods of using neoprene strapping were utilized to provide the dynamic pull to simplify the supplies required and improve ease of use for the patient. Methods Using the “I splint” for elbow flexion contractures as a model, we fabricated a smaller version for use in finger PIP and DIP flexion contractures using thermoplastic material and neoprene strapping (Figure 1a). A novel splint for thumb abduction/extension in treatment of first web space scar contracture (Figure 1b). Based on a traditional MCP flexion splint, we utilized neoprene strapping instead of springs or rubber bands and a plastic D ring instead of metal outrigger (Figure 2). Splint wear started at 1x/ day for 5 minutes and progressed to 3-5x/day for 5-15 minutes as tolerated. Results Digit PIP or DIP extender (figure 1a.) after 1 week of daily wear improved PIP extension from 45 degrees (of flexion) to 25 degrees and DIP extension from 50 degrees to 30 degrees. Thumb Post Splint (figure 1b.) after 2 weeks of daily wear improved radial abduction from 45 degrees to 58 degrees. Dynamic MCP flexion splint (figure 2) after 1 month of daily wear improved left ring finger active MCP flexion from 0-20 degrees to 0-40 degrees. Left small finger active MCP flexion improved from (-50) - 0 degrees to (-40) - 5 degrees (negative parenthetical value denotes hyperextension). Conclusions Dynamic splints utilizing neoprene strapping contributed to improved range of motion for all patients included in this case series. Therapists noted that splint adjustments were infrequent and minimal throughout time of use. Patients reported ease of use and compliance with splint wear schedule outside of therapy sessions. The amount of time spent fabricating compared to traditional methods was not tracked and would be an interesting point to consider in the future. Applicability of Research to Practice We hope that this presentation may give other practitioners new tools to address common burn scar contractures of the hand and simplify both the fabrication process and materials required for dynamic splinting.

Radiological long-term follow-up up to 12 years of initially ultrasound unstable hip types D, III and IV after treatment with the Tübingen splint worn as a plaster

IntroductionThe treatment of ultrasound unstable hips with the Tübingen splint is currently under discussion. However, there is a lack of long-term follow-up data. This study presents to the best of our knowledge first radiological mid-term to long-term data of the successful initial treatment with the Tübingen splint of ultrasound unstable hips.Materials and methodsFrom 2002 to 2022 the treatment of ultrasound unstable hips type D, III and IV (age ≤ 6 weeks, no severe limitation of abduction) with the Tübingen splint worn as a plaster is evaluated. Based on data derived from routine X-rays during the follow-up period, a radiological follow-up (FU) analysis until the age of 12 years was performed. The acetabular index (ACI) and center–edge angle (CEA) were measured and classified according to Tönnis as normal findings (NF), slightly (sliD) or severely dysplastic (sevD).Results193 of 201 (95.5%) unstable hips could be successfully treated showing normal findings with an alpha angle > 65°. The few patients showing treatment failures were successfully treated applying a Fettweis plaster (human position) under anesthesia. The radiological FU of 38 hips showed a favorable trend with increase of normal findings from 52.8% to 81.1% and decrease of 38.9% to 19.9% of sliD respectively 8.3% to 0% of sevD hips. The analysis of avascular necrosis of the femoral head showed 2 cases (5.3%) of grade 1 according to Kalamchi and McEwen, which were improving over time in the further course.ConclusionsThe Tübingen splint as alternative to replace a plaster has proven a successful therapeutic option for ultrasound unstable hips type D, III and IV with favorable and over time improving radiological parameter up to the age of 12 years.

Three-dimensional evaluation of sleep bruxism-related splint wear using a dental laboratory scanner: A preliminary clinical study.

The wear depth on the occlusal splint (OS) is reportedly associated with the sleep bruxism (SB) level, as evaluated using portable polysomnography (PSG) recordings. However, the OS is deformed owing to SB forces, possibly preventing the accurate quantification of the wear facets. We aimed to introduce a newly developed system to quantify the wear facets on the OS using a dental laboratory scanner (D810) and investigate the association between the wear facets, as evaluated with this system, and the SB level. Ten healthy individuals who were diagnosed with SB based on portable PSG recordings participated in this study. They were asked to wear the OS for 2months. The first day after a 2-week adaptation period was defined as the reference day, and sequential scanning of the OS surface was performed on days 15, 30, and 45. Changes in the OS surface from the reference day allowed dimensional evaluation of the wear facets in terms of maximum wear depth, wear area, and wear volume. Multiple regression analyses were conducted to test whether each of these variables could be predicted by any of the SB-related variables. The total duration of SB episodes per hour of sleep and the maximum muscle activity were significantly associated with the wear area, as measured with our system (adjusted R-squared was .78, p < .01). Our system allows dimensional analysis of the wear facets on the OS surface in association with the SB level.

LOW TEMPERATURE THERMOPLASTIC SPLINTING IN THE MANAGEMENT OF CONGENITAL TALIPES EQUINOVARUS

Congenital talipes equinovarus (CTEV) is one of the most common congenital deformities. Treatment of clubfoot should begin at the earliest to have the best outcome. The goal of treatment is to eliminate all deformities of CTEV so that patient has a functional, pain free, plantigrade foot with good mobility within minimum time duration. Treatment includes non-surgical and surgical methods. Conventionally Plaster of Paris (POP) is used for splinting though leather, polypropylene and rubber are also used. Objective of this study is to evaluate the effectiveness of low temperature thermoplastic (LTTP) splinting in CTEV management. This is an on observational study over a period of one year in Thirty-two CTEV patients with Pirani score of less than three. Effectiveness of LTTP splinting was evaluated in detail. It was found that LTTP splinting was cost effective, cosmetically better, reusable, demoldable, and easier to apply. It was of light weight, and required lesser time. It avoids the need for repetitive casting and same splint can be used as maintenance splint also. Pirani score lowered from 3 to 0 after 6 months of splinting. Conclusion –The compliance in donning the splint was high and acceptable among the children studied. Parental satisfaction regarding the splint wearing time and correction of deformity factor was high. Skin complications associated with POP casting were absent in the study population. Hence correction of CTEV with LTTP splinting was more effective than conventional POP casting.

Variation in patient information and rehabilitation regimens after flexor tendon repair in the United Kingdom.

There is clinical uncertainty regarding the optimal method of rehabilitation following flexor tendon repair. Many splint designs and rehabilitation regimens are reported in the literature; however, there is insufficient evidence to support the use of any one regimen. The aim of this study was to describe rehabilitation guidelines used in the United Kingdom (UK) following zone I/II flexor tendon repair. Using a cross-sectional design, hand units in the UK were invited to complete a short survey and to upload their flexor tendon rehabilitation guidelines and patient information material. Approval was granted by the British Association of Hand Therapists. Data were extracted in duplicate, using a pre-piloted form, and analysed using descriptive statistics. Thirty-five hand units responded (21%), providing 52 treatment guidelines. Three splinting regimens were described, and all involved early active mobilisation: (i) long dorsal-blocking splint (DBS); (ii) short DBS; and (iii) relative motion flexion splint. Duration of full-time splint wear ranged from 4 to 6weeks. There were variations in splint design and composition of home exercise programmes, particularly for the long DBS. Where reported, recommended return to driving ranged from 8 to 12weeks, and return to light work activities ranged from 5 to 10weeks. Treatment guidelines varied across UK hand therapy departments, suggesting that patients receive differing advice about how to protect, move and use their hand after zone I/II flexor tendon repair. The disparity in splint wear duration, home exercise frequency and prescribed functional restrictions raises potential financial and social implications for patients. Future research should explore rehabilitation burden in addition to clinical outcomes.

Surgical Treatment of Complex Axillary Scare Contractures: One Case Report

Background: Axillary scar contracture is frequently observed after severe burn insult and is usually accompanied by scarred adjacent area. These scars result in adduction deformity, which may be severe and diffuse. The lack of adequate treatment in the acute phase leads to complex scars that require different surgical techniques depending on the clinical examination of surgeon. Aim: Expose the possible surgical techniques, their advantages and disadvantages in the case of burning of the entire axillary hollow. The surgical management of linear scares contractures will not be discussed in this article. Case presentation: This is a rare clinical case of a 12-year-old girl who was burned at the age of 5 with disabling functional sequelae of the axillary area (limitation of the abduction to 30 degrees). The patient is treated at ALGHASSANI Hospital in Fes city/Morocco. Parental consent was taken for scientific publication. Results: We did two surgical interventions: the first starting with excision of the scar tissue leaving a loss of skin covered by a laterothoracic IC fasciocutaneous flap. The second one was a semi-thick skin graft to cover the supero and infero external quadrants of the left breast. We obtain the abduction at 110 degrees. Conclusion: Early surgical management of deep lesions within 21 days of the burn associated with prolonged rehabilitation and the wearing of compression garments and splints are essential elements in the prevention of these axillary contractures.

Occlusal Splint Therapy Followed by Orthodontic Molar Intrusion as an Effective Treatment Method to Treat Patients with Temporomandibular Disorder: A Retrospective Study

Our goal is to show that temporomandibular disorder (TMD) patients with orthopaedic instability can be effectively treated by the combination of occlusal splint therapy and molar intrusion. Diagnostic records of 18 patients reporting previous TMD and treated with splint therapy were evaluated. Postsplint anterior open bite was treated by skeletally anchored molar intrusion. Changes in overjet (OJ), overbite (OB) were measured on articulator mounted models: initially in maximal intercuspidation (MI), centric “de jour”, postsplint centric relation (CR) and postintrusion CR. Changes in ANB (A point-Nasion-B point) angle, mandibular plane–palatal plane angle and facial axis angle were assessed on lateral cephalograms. Morphological changes of the condyle were detected on pre-and posttreatment CBCT images. When compared screening mountings to MI models, significant differences were found in OJ and OB. Following splint wear, there was a significant increase in lower facial height and significant decrease in facial axis angle, which in turn increased ANB angle. OB and OJ showed a significant change on the postsplint mountings when compared to MI. After intrusion, mandible exhibited counterclockwise rotation, which decreased lower facial height, increased OB and facial axis angle and decreased ANB and OJ. Posttreatment CBCTs confirmed improved condylar morphology.Occlusal splint therapy followed by orthodontic molar intrusion provides MI-CR harmony, therefore, it seems to be an effective method for treating TMD patients.

Plantar Pressure Variations Induced by Experimental Malocclusion-A Pilot Case Series Study.

Background: All body systems involved in ensuring a healthy posture (musculoskeletal system, oculomotor, oto-vestibular and occluso-cranial-mandibular) are essential in maintaining postural balance. Research Question: Does experimental malocclusion in subjects in static position determine variations in plantar pressure? Methods: Overall, 31 subjects were included in the study. The plantar pressure was evaluated in five different points: lateral and medial heel, midfoot, 1st and 5th metatarsal area. Using a specially designed splint, an artificial malocclusion was induced on the right hemimandibular arch. The pressure was measured at 0 (T0), 15 (T1) and 30 min (T2) after splint application. Results: The right external plantar sensors recorded statistically significant differences in pressure values after 15 min of splint wear (5th metatarsal area, p = 0.05; midfoot, p = 0.04). Important pressure values were also recorded by the left internal plantar sensors (1st metatarsal, p = 0.01; medial heel, p = 0.006), after 30 min of splint wear. Conclusions: Asymmetrical experimental malocclusion produces early changes in plantar pressure, a proof of compensatory mechanisms induced by secondary postural imbalance.

Features of the course of comorbid somatic pathology depending on the method of treatment of lower jaw fracture without displacement of fragments

AIM: The aim is to study the effect of the method of reducing the fractures of the mandible without displacement of fragments on the course of comorbid somatic pathology&#x0D; &#x0D; MATERIALS AND METHODS: The study included 60 patients (45 men and 15 women) aged 18 to 69 years with fractures of the mandible without displacement of fragments and comorbid somatic pathology. The subjects were divided into three groups. The first group included 20 patients who received intraosseous orthodontic screws with intermaxillary rubber traction. The second group consisted of 20 patients who underwent immobilization with a Tigerstedt splint with intermaxillary rubber traction. The third group included 20 patients who underwent immobilization with a Vasiliev double-mandibular splint with intermaxillary rubber traction. We studied the effect of the method of reducing of fractures of the mandible without displacement of fragments on the course of comorbid somatic pathology.&#x0D; RESULTS: As a result of the treatment in the first group, angina pectoris became unstable in 1 patient, which required a consultation with a cardiologist and correction of treatment. In the second group, in 3 patients (15%) with chronic polyarthrosis, prolonged wearing of dental splints resulted in the aggravation of deforming osteoarthritis of the TMJ and longer outpatient rehabilitation was required. In the third group, 13 patients (65%) with diabetes mellitus and ischemic heart disease demanded a prolonged oral tissue regeneration.&#x0D; CONCLUSIONS: When choosing a method for reducing a fracture of the lower jaw, it is necessary to take into account the features of comorbid somatic pathology. The conservative method of treatment using dosed intermaxillary elastic traction is the most gentle.

Use of occlusal digital splint for treating the patients with temporomandibular joint dysfunction and planning orthopedic treatment

Objective of the study: to develop and assess the occlusal digital splint for treating patients with temporomandibular joint dysfunction (TMJD). Material and Methods — 17 patients between the ages of 30 and 49 diagnosed with TMJD were admitted for treatment. To normalize mandibular position, an occlusal digital splint for all patients was manufactured in accordance with our original method. An intensity of pain sensations in all patients prior to, and after, the treatment was assessed by a visual analogue scale, along with the changes in the mandibular movements’ amplitude, and the signs of splint wear and stability of occlusal contacts. Results — Patients have adapted themselves well to the splint and found it convenient in use. The study results showed that it was sufficiently effective in treatment of TMJD. Reduction in pain intensity and restoration of mandibular movements’ amplitude were detected with certainty. Only in 2 (11.7%) cases, the signs of wear on the splint were found, as evidenced by the changes in pre-treatment occlusal contacts. In all other cases throughout the study, a stable occlusal contact has been encountered. Conclusion — Our results indicated that proposed occlusal digital splint may be considered as a treatment option for the patients with TMJ disorders.

73 Objective Measurement of Adherence with Splint Use After Burn Injury

Abstract Introduction The prescription of splints (orthoses) to help protect vulnerable structures and maintain range of motion after skin grafting is an integral and important part of burn recovery. The degree to which a patient adheres to wearing a prescribed orthosis is believed to play a major role in outcome. However, orthoses may be uncomfortable or undesirable to wear, affecting a patient’s adherence. At our burn center, orthosis application and wear is heavily dependent on staff when patients are in the ICU. As patients move to the acute ward, the responsibility for orthotic use is shared by family and staff and as outpatients, caregivers are primarily responsible. The purpose of our study was to use temperature sensors implanted in the orthoses to objectively determine compliance rates with splint wear during these three different stages of burn recovery. Methods Pediatric patients with skin grafting to the hands who were prescribed a hand splint had a temperature sensing device implanted into their orthosis when it was fabricated and prescribed for wear. The sensors detected higher temperatures when the orthosis was on the patient and lower temperatures when it was not, providing an objective means to determine frequency and duration of wear. The data collected for each patient was compared to the prescribed time as noted in the medical record by the treating therapist. Data was analyzed using descriptive statistics and one-way ANOVA. Results Data were recorded for an average of 50 days for 12 patients using 17 splints during three continuous phases of care: ICU, acute ward, outpatient. Patients in ICU wore their splints 10.4 hours per 24 hour period, resulting in a 102% hourly compliance based on the prescribed wear time. During acute ward care, patients wore their splints for 7.6 hours (89% hourly compliance). As outpatients, subjects wore their splints an average of 6.7 hours (82% hourly compliance). There was no statistical difference in orthotic adherence between the phases of care. Daily compliance (days worn/ days prescribed) showed a similar trend: ICU=100%, ward=90%, OP=88%. Patients or their caregivers were asked to rate their own adherence with splinting at 8 weeks after injury using a 1–4 Likert scale. All but one patient reported the highest level of compliance and described use “as instructed by therapist” (92%). Conclusions This is the first study to objectively measure patient adherence with wearing orthoses over the course of burn recovery. Results show high level of adherence in ICU but demonstrate declining adherence as the patient and caregiver assume more responsibility. This study highlights potential areas for improvement in patient education during transition of care from inpatient, and highlights the need for better understanding of the barriers that exist for long-term orthotic use after hospitalization. Applicability of Research to Practice Prevention of contracture with splints.

76 The Effect of Splinting of Metacarpophalangeal Joints After Skin Grafting: A Review of the ACT Database

Abstract Introduction Hands are the most common area of the body to sustain a burn injury. Maintaining motion and function throughout the healing process of a burn injury is one of the most important goals of the rehabilitation process. After a deep burn to the dorsal aspect of the hand requiring skin grafting, the adjacent metacarpophalangeal (MCP) joints are at risk for developing a burn scar contracture (BSC), limiting the joints’ ability to fully flex towards a fist position. Post-operative positioning protocols state that patient’s hand should be temporarily immobilized for graft protection. A resting hand splint is used to maintain the wrist in approximately 20–30 degrees of extension, MCP joints at approximately 50–70 degrees of flexion and the interphalangeal joints in full extension. The purpose of this study was to assess the benefit of splinting as a treatment intervention to prevent MCP joint extension contractures following dorsal hand skin grafting. Methods This was a retrospective review of prospectively collected observational data from the “Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Time Related to Patient Outcomes” (ACT) study. Patients were included with grafted dorsal hand burns occurring within 1 of the 4 established cutaneous functional units (CFU) along the dorsal aspect of the second through fifth metacarpals. Since most subjects had more than one dorsal hand CFU involved, the number of CFUs were analyzed as opposed to the number of subjects. Isolated MCP joint flexion measurements were utilized to determine incidence of contracture. Included causes of contracture were scar tissue or other soft tissue limitations. Data were then analyzed by two groups: contracted and non-contracted. Results A total of 221 dorsal hand CFUs were included in this study; 119 contracted and 102 non-contracted. There was no statistical significant difference between the average splint wear time between the 2 groups. The average percent of affected CFUs grafted within the contracted group was 92.4% compared to 76.8% in the non-contracted group. In burns to the dorsal hand with less than 99% of the CFU grafted, splinting was effective in preventing 60% of MCP joint extension contractures. When greater than 99% of affected CFU was grafted, splinting was effective in prevention only 36% of contractures. Conclusions Splinting can be an effective intervention option in preventing MCP extension contractures when less than 75% of the affected CFU has been grafted; however, its effectiveness decreases as the percentage of CFU involvement increases to greater than or equal to 99%. Applicability of Research to Practice Determine most effective post-operative rehabilitations plan following dorsal hand skin grafts.

836 Custom Fabricated Open Anterior Ankle Foot Orthosis to Promote Early Mobility with Lower Extremity Grafts

Abstract Introduction Distal lower extremity STSG’s present a challenge with the balance of early mobility and immobilization of the ankle. Traditional commercially available ambulation boots or pre-fabricated orthotics may impose circumferential compression endangering graft integrity. Custom fabricated posterior AFO’s comprised of thermoplastic, scotch cast or fiberglass materials are not recommended for weight-bearing of the lower extremity during mobility/ambulation. What may also hinder promotion of early mobility is having a multitude of injuries or advanced age with decreased ability to adhere to a LE NWB status. An anterior approach to immobilization of the ankle was thought of to free the plantar surface of the foot for weight-bearing. The open concept of the orthosis itself minimizes direct contact with the involved LE graft. This promotes graft integrity during mobility with ankle immobilization. Methods Materials: Thermoplastic material, scissors, strapping, dense adhesive foam, adhesive Velcro and a heat gun. Fabrication: Measure the point of distance between where the desired proximal end of the orthosis would be to the patient’s metatarsal heads on the dorsal aspect of the foot; double it to calculate the amount of material needed. The width of the material should be approx. 3 to 4 inches. Warm material and tri-fold it together reducing width to approx. 1 ½ to 2 inches to increase stability. Shape the folded material into a continuous oval and place on the patient’s distal LE. As the material cools, shape the oval away from the medial/ lateral aspects of the distal LE restricting the points of contact to the anterior most proximal and distal aspect of the desired splint parameters. Remove once cooled and add dense adhesive foam to the 2 points of contact that will rest against the patient. This will allow for a slight area of “give” against the patient during weight-bearing of the LE/foot. Velcro and straps are added to the proximal/distal ends of the oval; heating the adhesive side will imbed the Velcro allowing increased durability with repeated donning/doffing. Results The open construction of this orthosis allows different degrees of weight-bearing eliminating contact with the distal LE STSG. The forefoot and heel are available to weight bear safely within the confines of the open anterior ankle foot orthosis. Conclusions Patients have been trialed with/without an AD with success in the achievement of ankle immobilization with mobility. Weight-bearing instructions that accompany this splint wear is foot placement rather than a normal heel strike cadence to avoid undue pressure at the proximal aspect of the splint on the lower extremity. Applicability of Research to Practice This splint has been successfully utilized for immobilization without compromise to STSG integrity due to the anterior open support it offers the ankle. Perhaps this concept could be applied to other joints to avoid direct contact of the splint with STSG during the initial stages of healing.

Understanding OT Practice Regarding Home-Program (HP) Creation for Individuals Postburn

Abstract Date Presented 04/04/19 Secondary effects of burn injury, such as scarring and contractures, impair occupational performance. Home programs (HP), which may include exercises, splint or garment wear, and functional activities, are used by OT practitioners to extend care postdischarge. This study utilized a descriptive survey to gather information from OT practitioners across the US. This poster will describe OT practice patterns for this population. Primary Author and Speaker: Ann Cook Additional Authors and Speakers: Elena Donoso-Brown, Margaret Hyland

101 Adherence to evidence-based care of distal forearm buckle fractures in a tertiary care pediatric emergency department

Pediatric buckle fractures of the distal forearm are a common reason for emergency department (ED) visits. Evidence has clearly demonstrated that a removable splint is as good as a circumferential cast for treatment of these injuries, and may be superior with respect to patient preference and return to activity. Children should be instructed to wear the splint for comfort only, without a specific duration of wear. These injuries are safely managed without primary care physician (PCP) or orthopedic follow-up. Our objective was to assess the adherence to evidence-based recommendations for isolated distal forearm buckle fractures in a tertiary care pediatric ED. Our primary outcome was the proportion of patients treated with a splint. Secondary outcome measures were the proportion of patients a) instructed to wear the splint for comfort only without a specific duration of wear, and b) receiving instructions for no required follow up. A retrospective chart review of all children < 18 years presenting to a pediatric ED between May 1 to July 31, 2017 was conducted. We identified children with fractures of the forearm using ICD-10 codes (S52.500, S52.580, S52.590, S52.600 and S52.800). The electronic medical record was reviewed to identify patients with isolated buckle fractures of the radius and/or ulna as diagnosed by the ED physician and confirmed by radiology report. Of the 274 patients identified by ICD-10 code, 83 had an isolated distal forearm buckle fracture. 93% were treated with a removable splint, and 7% received a cast. For splint wear instructions, 29% were told to wear as needed for comfort, 47% were told to wear continuously and 24% had no documentation of splint instructions. Of children who were told to wear the splint continuously, 6% were instructed to wear it for 7 days, 6% for 10 days, 39% for 14 days, and 49% for ≥ 21 days. 48% of patients were asked to follow up with their PCP, 10% were referred to orthopedics and 31% were told no follow-up was required. Only 17% of patients were managed with all 3 recommendations for evidence-based care. Although good evidence for management of isolated buckle fractures has existed for over a decade, adherence to evidence-based care in our centre varied by measure, ranging from 29% to 93%. Only 17% of patients were managed with full adherence to recommendations. This data lays a foundation for targeted quality improvement initiatives in this area.

Occlusal Splints for Bruxing and TMD – A Balanced Approach?

Occlusal splints are classified in this article into three groups according to the way that opposing teeth contact the splint: 1) partial occlusal contact; 2) full occlusal contact in retruded arc of closure; and 3) full occlusal contact in protrusion. Each type of splint has relative advantages and disadvantages. Splints do not reliably or predictably reduce bruxism and there are differences between individuals in their response to the wearing of splints. When treating temporomandibular disorders, splints should be provided as part of a package of conservative physiotherapy type measures. There is no evidence that any one type of splint is most effective. Long-term wearing of designs that may lead to permanent occlusal changes should be avoided or the patient should be carefully monitored for occlusal changes. CPD/Clinical Relevance: The article describes the effect of splints on bruxism. Advice is provided on best practice in respect of the use of splints in the management of temporomandibular disorders.

Cathodal tDCS of the parietal cortex combined with mirror therapy improved hand dexterity in a case of focal dystonia

The role of not-invasive brain stimulation (NIBS) as an add-on treatment to motor training in children suffering from focal dystonia has described in the literature with contrasting results. The study is aimed at describing the clinical and functional outcome observed in a 13-years-old girl suffering from hand dystonia and undergone NIBS combined with mirror therapy. We report the case of a 13-year-old girl suffering from hand dystonia following right hemisphere lesion in the basal ganglia area, due to cerebrovascular accident occurred in the infancy. At the basal assessment she showed a complete muscle strength recovery, a quite normal gait pattern, but a complete impairment in left hand dexterity due to hand muscle dystonia. She had already undergone several training protocols, including splint wearing and repeated botulinum toxin injections. These last induced a partial resolution of muscle contraction at rest, without any improvement in hand dexterity. We proposed the following treatment protocol: daily sessions (20 minute each) of cathodal tDCS on the right sensorimotor cortex (P4), 1 mA, followed, in the same morning, by 20 minutes mirror therapy, for five consecutive days. Functional status was assessed using the Fugl-Meyer upper limb score at baseline (T0), after treatment end (T1) and one month later (T2). Moreover, a fMRI was performed at T0 and T1, in order to look what brain networks were activated during the left and right limb movements. The NIBS was well tolerated. No adverse events were complained for. The Fugl-Meyer score increased from 21/66 (T0) to 29/66 (T1) and up to 30/66 (T2). The fMRI showed a significant reduction of brain activation under active left limb movement after treatment. Parietal cortex inhibition via cathodal tDCS at the lesioned hemisphere was effective at reducing dystonia, improving voluntary movement and inducing the reorganization of brain networks.