UE Orthotics for Spinal Cord Patients

prevent deformity, prevent overstretching of muscles, maintain integrity of joints and arches of hand, increase functional use of hand, increase independence in early SCI

Why do we splint for SCI UE?

promote tenodesis, maintain long length, preserve natural hand function, cosmesis, hygine, increase function, spasticity 

outcomes for splinting

Wrist- neutral to 30 degrees extension, Normal transverse and longitudinal arches, moderate tendon shortening for tenodesis, Thumb- abducted and opposed, preservation of web space 

functional position of hand

easier to prevent than remediate deformities, better acceptance, increase independence, decrease frustration 

why early intervention?

MMT, Sensory, Existing Deformities, Patient Interview, ASIA level

Functional hand components

-maintain functional position

-observe and address tone increase

-educate on PROM

-educate on proper UE position

-provide wrist support for day

-provide wrist/finger support at night

C1-C4 hand

Cock Up Splint 

Day splint for C1-C4 that provides wrist extension with forearm support, wrist neutral to 30 degrees extension, supports arches, fingers are free, custom fit

resting hand splint

Night splint for C1-C4 that provides functional position, wrist in 20-30 degrees extension, MPs 15-20 degree flexion, fingers abducted 10-20 degrees flexion, thumb abducted and opposed under first finger, web space and arches supported

Long Opponens Splint 

C5 hand splint with wrist in neutral, thumb placed in opposition in PINCH position, used to stabilize objects in functional tasks 

elbow flexors, hand contractures

C5 has strong ______ which puts them at risk for _______

Intrinsic Minus Hand (Claw Hands)

imbalance between strong intrinsic and weak intrinsic muscles, MCP hyperextension and PIP/DIP flexion

MCP Block Splint

splint for intrinsic minus hand/claw hand 

wrist drop

C1-C5 is at risk of

tight web space

C1-C7 is at risk of

extended flat hand, functional webbing in hand dies

C7 is at risk of

wrist extensor contracture due to supination with gravity  

C5 is at risk of 

C1-C7

what levels are at risk of tight web space?

C1-C5

what levels are at risk of wrist drop?

C7

what levels are at risk of flat hand?

C5

what levels are at risk of wrist extension contracture?

weight lifting cuffs, bowel stimulator, catheter holder, universal cuff

examples of adaptive equipment

functional electrical stimulation (FES), tendon transfer, nerve transfers, joint fusion 

long term alternatives to splinting

wrist extension, elbow extension, and finger flexion

most common tendon transfers are for

above 4

tendon transfer must have muscle grade _________

lose one muscle grade

a transfered muscle will _______

immediate on/off, no dependency period, increased cost, less likely to wear long term 

risk and benefits of neuroprosthesis

dependency period, risk loss of function, infection, deformity, cost, permanent

risks of surgery