"no-no splint" responces

"no-no splint" responces

Steve S

5/17/1999

Thanks to all who responded to my inquiry on no-no splints. Here is a
list of the responces:

We have made several for TBI patients over the years. We made custom
splints
after the O. T.'s had made them low temp splints. The low temp
orthoses did
not hold up. I know times ae changing and every payor wants cheap
orthoses
which function as well as custom. Good luck.


Sometimes small knee immobilizers are adequate. My experience has been
that
low temp materials are tried by OT but they don't hold up on certain
kids.
I have made bi-valved PE models, anterior only with straps, I did a
simple
metal with plastic cuffs. Some kids are strong enough and persistant
enough
to require reinformcement to the anterior shell. My goal has generally
been
effectiveness along with being able to keep it clean.


I have done sveral of these over the past years. I do custom ones.
Make certain the prescrption does not state abusive behavior as the
reson for fitting. It will get rejected. Arm positioning, prevention
of contracture, etc.


Contact J.T.Posey co in Arcadia, Calif.


I know that I have seen such a device but cannot say where. How about
using
a pediatric universal knee splint?


Have you considered the knee extension orthosis produced by Cascade of
dynamic AFO fame? I have used the smallest size on elbows before. It
has a
hinge that would allow some elbow flexion--the amount of extension is
related
to how much ROM is present and how tightly you tighten the elbow
counter pad.
 It is lined and fairly well tolerated., although I have never used it
for
your intended goal. It is prefabricated.


You could use humeral and ulnar sleeves by Orthomedics and small elbow
jounts from Johnson's Orthopedics as an off the shelf arm brace.


I know of prefab plastic tubes (may have even been a little conical).
It is
20 years ago and they were available in Germany in the durable medical
equipment branch (those who serve hospitals with their equipment).


WE MAKE THEM ALL THE TIME, USE A DOUBLE UPRIGHT WITH A RANGE OF MOTION
JOINT
WITH PLASTIC CUFFS COVERD WITH VELFOAM. SET THE PATIENT IN AS MUCH OF
RANGE
OF MOTION AS POSSIBLE JUST LIMITING THE FLEXTION YOU DO NOT WANT.

I have made such orthoses in pediatric cases as you describe. I am
unaware
of any off the shelf item, and would be suspect. The folks wearing
this type
of orthosis will give zero feedback, as I know you are aware. There
was an
old CPO Journal which described an elbow flexion contracture ox which
will
generally work well. It consists of fabricating a half inch custom
plastizote cone, heating it, and fitting over the person's arm. The
person's
arm is prepared with several (3?) layers of stockinette, the last is
left
long over the hand to assist pulling the heated cone over the limb.
One
formed it was removed and reinforced as deemed necessary. There is
more to
the process but this is all I remember.

God bless,


I have made these out of copoly for very strong clients (or patients)
to
keep them from hurting themselves.
They seen cruel but are better than the alternative.
They were custom molded bi-valve design lined with foam at high
pressure
areas with flared edges to spread the edge pressure on the anterior
surfaces.


Try orthoamerica, they have an elbow splint with an elbow jt. that can
be
locked in a number of positions


there are a number of elbow braces on the market which would be
effective for your needs, one of which is our PRIME elbow system.


IMHO, custom is so simple on this EO, that I prefer it to OTC. Unless
you're good with low temp, it can take almost as long as custom.
Usually,
1/8 copoly with a band of foam at the elbow is adequate but depends on
the
patient. Polyethylene works but doesn't hold up as well. Polypro is
too
stiff.


I've not encountered a situation like this. But if the abuse is
islated to
the head or face might a waist belt with appropriately shortened wrist
cuff
straps attached to it suffice.


I have had several opportunities to treat similar conditions in
children and
young adults. Very often I have been able to use the pediwrap from
Medi-kid Co @ 888.463.3543. It comes in several sizes it is easy to
use.


We have had several cases in dealing with this population and have
found that custom designed systems were the best way to go. Custom
orthoses provide the strength you may need to prevent or at least
control the unwanted self-abuse. Also with custom devices, you can
also design the device to be escape proof. Some of these
individuals are quite adept at escaping these devices.


Many people just use off-the-shelf padded immobilizers for this, but I
always caution that due consideration be given to behavioral
consultation-
and it may be difficult to obtain in some areas, there are not as many
specialists with expertise in helping design programs for people with
severe to profound MR. But if you don't, the restraining may actually
make the behavior worse when they come out of restraints. I have a
dear
family where I hae advised and advised until I am blue in the face, but
we
cannot seem to get help; the mother has progressed to restraining all
four
limbs and now is asking me for a cervical collar, and I said NO and
explained once again but she is wrapping a towel around his neck now.
It
is desperately important to train rather than restrain, and to find
acceptable purposeful activites to susbtitute for the undesired ones.

If an elbow splint is used as a temporary or adjunctive measure, then
make
sure the child can still reach a wheelchair tray or other surface and
use
the hands in other activities that may be reinforcing.
Vikki Stefans, pediatric physiatrist (rehab doc for kids) and working


There are a few prefab elbow orthoses with joints that can be locked to
limit
motion. They are expensive and there is no appropriate L-code for them.
I
have a few patients that are in need of them. Medicaid may require
written
authorization for it, because I know of a case where it was denied
after it
was delivered, and upon repeal got paid $1. for it. I was planning to
make a
custom one out of an EVA foam sandwiching in a piece of PE for
reinforcement,
because she hits her leg and other people, so I wanted the outside
padded.
Then just velcro closure. Just an idea . Good luck -


As one can see, there are a variety of opiniions on the subject. I try
never to give away business but maybe the OT's would be better
qualified to handle these. they can remake a set every six months and
bill it out as a session, am I right?

My favorite solution from above was the Cascade DAFO knee splint one.
This would be durable, yet low cost. Otherwise, Wheaton knee
immoblizers have worked but they make it unconfortable due to heat
retention and also have hygeine challenges.

Thanks again

Steve S
Ann Arbor, MI


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