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Splints

• An Orthosis is defined as device attached or applied to an


external surface of body to improve function , restrict or
reinforce motion, or support a body segment.
Indications
• Assist gait
• Reduce pain
• Offloading
• Control movement
• Minimize progression of deformity
• Deformity correction
• Assist and improve movement and function
• Reduce muscle tone
UCBL
• For flexible pes planus in children and adolescents
• 3 point pressure principle
SMO
• Evolved from UCBL
• Stabilizes subtalar
and tarsal joints
• Flexible pes planus
• Mild to moderate
spastic equinovarus
Thermoplastic types
• Solid AFO
• PLS
• Spiral and hemi spiral
• Hinged
• Tone reducing
Solid AFO
• Prevents ankle
dorsiflexion, plantar
flexion and varus
valgus deviation
• Severe spasticity with
impaired motor
control at ankle foot
• Conditions requiring
immobilization of
ankle
PLS AFO
PLS AFO
• Compensating for weak ankle dorsiflexors by resisting ankle
plantar flexion at heel strike
• Offers no mediolateral control
• Foot drop
• LMN disease with stable ankle
• Anterior compartment syndrome
• Myotonic dystrophy
• Post polio syndrome
• Contraindicated in mild to moderate hypertonicity
Spiral AFO
• Used in presence of
weak ankle PF or DF
with moderate
mediolateral instability
and mild weak knee
extensors
• C/I: edema,
• Moderate to severe
spasticity
• Fixed ankle deformity
• Severe mediolateral
instability
Hinged AFO
• CP
• Stroke
• Mild Spasticity
• Less durable
• More expensive
• Prone to excessive
wear and early
failure
Tone reducing AFO
• Extends under toes
and up over the foot
medially and laterally
to maintain subtalar
alignment
• Spastic hemiplegia
• C/I: LMN paralysis
and hypotonia
Metal AFO
• Fluctuating edema
• Safer in insensate
skin
• Morbid obesity
• Patients choice
FRO
• Quadriceps weakness
• CP children with
crouch gait
• C/I: Hip/Knee flexion
contracture
• Genu recurvatum
• Cruciate ligament
insufficiency
• Extensor spasticity
PTB orthosis
• Foot ulcers
• Tibial fractures
• Painful heel
conditions
• AVN ankle/foot
• Charcot arthropathy
• C/I: vascular
insufficiency
• Knee instability
CROW
• Diabetic foot ulcers
• Neuropathic foot
ulcers
• Painful deformed
foot/ankle
KAFO and HKAFO
KAFO
• A KAFO is used to provide stability at the knee and ankle
while indirectly affecting hip stability through ground
reaction forces.
• It typically is prescribed for individuals who have little to
no quadriceps strength.
• An individual may require a hip component because of
the level of injury; hip flexion, knee flexion, or ankle
plantarflexion contractures; poor balance; or decreased
motor control..
HKAFO
• HKAFOs are selectively recommended for adults with
bilateral paralysis from spinal cord injuries
• Unilateral applications of HKAFOs are rare, except for
short-term use to provide protected ambulation after hip
arthroplasty
RGO
• One of the most
common HKAFOs
uses a mechanical
linkage to couple
flexion of one hip
with extension of the
other, which permits
a reciprocal step-
over-step gait.
• In theory, the hip extension of the weight leg enables the
orthosis mechanism to advance the unweighted leg.
• Unlike a swing-through gait that requires users to lift
body weight plus the weight of the orthosis, the RGO
relies on weight shifting and orthotic mechanics for
mobility.
Upper extremity orthoses
• FO, FHO, HO, WHO, EWHO(long arm spilt)
• Static: opponens splint, knuckle bender, cock up) and
• Dynamic
• Motion assist: flexion/ extension assist
• Deformity correction: ring splint, gutter splint with turn buckle
• Functional: Tenodesis splint, balanced forearm orthosis,
Gunslinger splint
WHO
• supports the wrist joint, maintains the functional
architecture of the hand, and prevents wrist–hand
deformities
• Patients with severe weakness or paralysis of the wrist
and hand musculature are appropriate candidates for the
static WHO.
• Without support, these individuals are at risk for
developing the ‘‘clawhand’’ deformity and/or
overstretching weak muscles
Resting WHO
SEWO
• SEWOs are frequently used to protect soft tissues or to
prevent contractures of soft tissues.
• Occasionally, these orthoses are used to correct an existing
deformity.
Static splints

Opponens splint
Long arm splint

Ring splint CTS splint


static deformity correction

Static progressive flexion Gutter splint with dial lock


Knuckle bender Cock up
Tenodesis splint

C6 level tetraplegia
Tenodesis splint
• The wrist-driven WHO (WDWHO, or flexor hinge WHO) is
a dynamic prehension orthosis for transferring power
from the wrist extensors to the fingers
• Active wrist extension provides grasp, and gravity-
assisted wrist flexion enables the patient to open the
hand.
• The WDWHO is an appropriate orthosis for the individual
with paralysis or severe weakness of the hand. Wrist
extensor strength must be at least grade 3+ (fair+), and
proximal strength must be functional.
• Candidates for the WDWHO have a functional level of C5
with some C6 return (wrist extensors), C6, and C7
quadriplegia..
Functional splints

Gunslinger splint: brachial palsy Mobile Arm Support


Gunslinger orthosis
• Some individuals with a brachial plexus injury have a
normal hand and wrist (intrinsic plus hand and wrist, C7–
8 spared) with proximal musculature weakness.
• In these cases, the gunslinger orthosis with a simple
forearm trough is sufficient to support the arm, position
it in space, and allow the hand to be functional.
• A painful, subluxing glenohumeral joint can be
deweighted and can benefit from the gunslinger SEO
with a simple forearm trough.
MOBILE ARM SUPPORT
• Mobile arm support (MAS) is an SEO that supports the
weight of the arm and provides assistance to the
shoulder and elbow motions through a linkage of
bearings joints
• The basic components of the MAS are the wheelchair
mounting bracket, the proximal arm, the distal arm, and
the forearm trough
• The MAS can increase upper limb function for patients
who have severe arm paralysis because of disabilities
such as muscular dystrophy, poliomyelitis, cervical spinal
cord lesion, Guillain-Barre´ syndrome, and amyotrophic
lateral sclerosis.
• Criteria for MAS use are as follows:
• Absent or weak elbow flexion (poor to fair)
• Absent or weak shoulder flexion and abduction (poor to
fair)
• Absent or weak external rotation (poor to fair)
• Limited endurance for sustained upper limb activity
for joint laxity: EDS

Lycra suit Knee orthosis