On-line CEUs

NAOT members with an active OTC credential can earn CEU credits toward recertification just by reading the “Tip of the Month” contained in each issue of the Orthotech Professional and answering a few short questions at the conclusion of the article. Members can either answer the questions in the print version of the newsletter and return them via fax or mail to the NAOT offices, or submit answers on-line by clicking on the link at the end of each article and completing the on-line questionnaire. To receive 1 CEU (Category 2) for each article read, you must include:

-Your full name
-NAOT member number
-Email address (if applicable)
-Answers to all questions
-OTC number

NAOT will maintain a database with these CEU submissions and provide a record of total CEUs earned at the end of each calendar year to all participating members. Members will still be responsible for logging these hours with NBCOT at the appropriate time for recertification.

TIP OF THE MONTH: May/June 2008
Dynamic Splinting

by Al Bryant, LO, CO, OTC

Dynamic splints, often referred to as active or functional splints, aid in initiating and performing movements by controlling the plane and range of motion of the injured part. This splint generates a mobilizing or supportive force on a targeted tissue that results in passive gains or passive-assisted range of motion (ROM). Dynamic splinting has proven beneficial in the treatment of joint stiffness due to immobilization or limited ROM as a consequence of fractures, dislocations, total knee replacements, and other traumatic and non-traumatic injuries. It is commonly used in the post-operative phase for prevention and treatment of motion stiffness in the knee, elbow, wrist, or finger. They are ideal for splinting a variety of body parts, including: elbows, wrists, fingers, knees, ankles, and toes.

The design of a dynamic splint allows for improved arm movement after certain injuries, such as a radius fracture or a tendon or ligament laceration of the hand. Splints are generally used to inhibit limb movement, but this is not the case with a dynamic splint, which actually increases movement by placing gentle, sustained force on the affected limb. Dynamic splints can enhance forearm rotation, allow fingers to extend while being passively flexed, and block any unrestricted movement. Treatment with dynamic splints can improve a patient’s movement by more than 50 percent.

Thermoplastic is, perhaps, the best material for building dynamic splints. Thermoplastic splinting can address several hard to accommodate restrictions that can’t always be placed in a cast or splinted with plaster or fiberglass. For example, phalanges can be accommodated in these splints without the bulk created by using other splinting types.

After surgical intervention to correct injuries to ligaments, thermoplastic splinting can be used on patients to immobilize certain areas while allowing controlled motion in other areas. For example, a wrist can be immobilized while allowing flexion to the fingers and blocking extension of the fingers past 90 degrees.

By applying measured resistance to each digit of the hand, this dynamic splint is used to ensure surgically repaired tendons maintain their length.

Patients with an external fixator or open wounds that would be normally windowed in a cast could be splinted dynamically, allowing for ease of access dressing changes. This approach will also allow you to visually examine the wound without removing the splint.

Billing codes are generous for these devices. Splint classifications terminology is not the same as the classic terms for casting. We can’t simply say long or short arm, PTB or Munster. The terms used should describe location, direction, and intent. Using the correct splinting classifications is also vital in coding for reimbursement. Suggested billing codes: L3906 (Custom Hand Splints), L3907 (Custom Thumb Spica), and L3720 (Elbow). Note: Dynamic Splints have additional codes for its moving parts that are added to the base splint.

Splinting Process
To begin you splinting process you will need the following essential equipment: heat source, splinting gun, hat guns, cutting devices, pliers, utility knife, hole punch, wire cutters and benders, low-temperature thermoplastic, goniometer.

To assist you in your dynamic splinting approach, remember: PROCESS.

1. Pattern Creation: Trace the area you desire to splint on exam or notebook paper.
2. Refine Pattern: Trim back to fit within the traced area, allowing folding creases.
3. Options of Material: Select type of plastic.
4. Cut and Heat: Cut an piece of plastic and heat it for a short period. Then lay the pattern over it and cut it out.
5. Evaluate Fit While Molding: Allow additional cutting and molding for a more precise fit.
6. Strapping and Components: Add velcro straps and hinges if necessary.
7. Splint Finishing Touches.

All materials should be partially heated about 30 seconds before a specific pattern is cut. Do not remove the splint from the body part too soon or the splint’s shape and fit may be lost. Materials with longer working times are recommended for complex splints requiring specific positioning or immobilization, such as those used on neurologically-involved patients. Materials with shorter working times should be used for patients without the ability to hold positions very long such as pediatric patients. Avoid overheating, as it can alter the material’s properties and lead to stretching, thinning and fatigue of the material. You can accelerate cooling with an elastic wrap soaked in ice water in situations where the patients cannot tolerate normal setting times. Before applying material to patient’s skin always check temperature on therapist’s skin.

Dynamic Splinting has proven to be quite beneficial in the healing process when timeliness and technique are properly addressed.

Another dynamic splint used to maintain tendon length after surgery.

About the Author: Alphonzo Bryant is ABC/BOCO certified Orthotist with 10 years of experience. He also is and NBCOT certified orthopedic technologist with 15 years of experience. Bryant manages an Orthotic department in a hospital environment with full duties in both areas.

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