Fabrication and Client Education

Low temperature thermoplastic materials (LTT)

softens between 130-180 degrees

High temperature thermoplastic materials

softens above 250 degrees

How do you choose which material?

patient population

diagnosis

therapists preference/familiarity

availability

client factors

Material content and properties

memory

drapability

elasticity

bonding

self-finishing edges

conformability

flexibility

durability

perforation

finish

color

thickness

Examples of tools and resources

scissors

splint pan

grease pencils

contact cement

velcro hook/pile

d-rings

outriggers

Finishing touches

padding

avoid pressure areas

finish edges

reinforcement

Types of padding

moleskin

molestick

polycushion

sticky-back T-foam

Assure that MD prescription for OT intervention provides clear info of...

diagnoses

purpose

involved body part

duration of orthosis wear

The MD prescription will guide your...

plans for orthosis fabrication and the education you provide to your client/patient

Factors that may influence adherence to home program

client understanding of medical necessity

social support

valued/necessary life roles/tasks performed while wearing orthosis

Considerations: cognitive status

attention

memory

problem solving abilities

performance analysis

Considerations: health literacy needs

demonstration

written information

pictures/graphics

writing directly on orthosis

Use ______ _______ for client to demo understanding

teach back

Guiding questions for wearing schedule

purpose

compliant

medical contraindications/precautions

patient tolerance of orthosis

assitance needed to don/doff

Clear instructions for orthosis care

avoid heat sources

cleaning procedures

keep away from pets

Precautions during orthosis fabrication and fitting

fragile skin

impaired sensation

fluctuating edema

impaired vision

Skin checking: darker skin tones

feel for changes in temp over boney prominences

watch for change in texture

watch for change in color

Change in texture in darker skin tones

smoother or shinier can indicate lack of blood flow

bogginess can indicate wound below surface

Skin checking: lighter skin tones

watch for redness around bony prominences and borders of orthosis

Areas of redness should not last more than...

15 minutes after removal

Stage 1 pressure injury: assessing dark skin tones

no visible blanching in response to pressure

redness may not be visible

Deep tissue pressure injury: assessing dark skin tones

may not be easily visualized

assess for pain and changes in skin temp

Inflammation: assessing dark skin tones

recently resolves areas of inflammation may appear darker

compare affected area with non-affected skin for temp, color, shine, tautness, pitting edema and pressure

Ecchymoses (bruising): assessing dark skin tones

bruised areas may appear darker and may be tender when palmated

Finger gutter orthosis can be used to treat

PIP and DIP fractures/sprain

contractures

mallet finger

tendon laceration

Considerations for finger gutter fabrication

know where injury is

MCP creases should be clear to allow for full ROM

changes in edema may require orthosis modifications

Volar wrist orthosis can be used to treat

carpal tunnel

radial nerve palsy

wrist sprain/fracture

RA exacerbation

drop wrist

Considerations for volar wrist fabrication

condition will guide wrist angle

allow for full thumb ROM

radial and ulnar styloids are potential pressure points

orthosis should not limit hand function

Short opponens can be used to treat

skiers thumb

gamekeepers thumb

golfers thumb

thumb CMC osteoarthritis

Considerations for short opponens fabrication

thump IP joint is typically left free

allow for full wrist ROM

thumb is typically in palmar abduction

Resting hand can be used to treat

RA exacerbation

burns

crash injuries

complex regional pain syndrome

acquired brain injury

radial nerve injury

Considerations for resting hand fabrication

position of joints will vary depending on clients condition and goals of treatment

lots of joint included means lots of potential pressure areas

Long opponens can be used to treat

dequervain tenosynovitis

thumb CMC osteoarthiritis

RA exacerbation

tendonitis

scaphoid fracture

Considerations for long opponens fabrication

thumb IP joint is typically left free

thumb is typically in palmar abduction

radial and ulnar styloids are potential pressure areas