upeer limb ortosis is now a day use very fraquently. this ppt provide general guidelines and information on common parts of the orthosis and some recent advances.

1. UPPER LIMB
ORTHOSIS
SANA MASROOR
MPT-2ND
SEM
2018

2. ORTHOSIS
Upper extremity orthoses are devices applied externally to
restore or improve functional and structural characteristics of the
musculoskeletal and nervous systems.
They are used frequently on patients who have neurologic
problems, such as stroke, TBI, MS, CP, SCI, and PNI. They often
are used in arthritic conditions as well.
The material used in orthotic devices includes low-temperature
thermoplastics that can be custom-made for fit and other
appropriations.

3. BIOMECHANICAL PRINCIPLES
 Three-point control concept
 Tissue tolerance to compression and shear forces
 The biomechanics of levers and forces
 Selection of materials
 Static versus dynamic control

4. ANATOMICAL PRINCIPLES
Proper upper limb positioning requires an understanding
of multiple anatomical issues, particularly when a joint is to
be immobilized.
Wrist immobilized in slight extension and neutral
pronation/supination.
IP in extension and MCP in flexion
Thumb opposite to finger
Individual finger point to the scaphoid

5. FUNCTIONS OF UPPER EXTREMITY
ORTHOSES
Increase range of motion (ROM)
Immobilize an extremity to help promote tissue healing
Apply traction either to correct or prevent contractures
Assist in providing enhanced function
Serve as an attachment for assistive devices
Help correct deformities
Block unwanted movement of a joint

6. General Classification
Type
• Static
• Dynamic
• Hybrid
Function
• Flexion
• Extension
• Abduction
• Adduction
• Rotation
Region
• Volar or Dorsal
• Joints crossed
* Finger / thumb splint
* Wrist Splint
* Wrist Hand Orthosis
(WHO )
* Elbow (WHO)
* Shoulder (Elbow-
WHO)

7. Key Components of the Upper Limb
Shoulder: Positioning and support critical
Elbow: Emphasis on flexion
Wrist: Achieve most optimal placement and ROM
Fingers: Proper positioning for patient goals
Thumb: Primary emphasis for prehension and grasp

8. Basic Components
C-Bar
Connector bar
Crossbar
Cuff or strap
Deviation bar
and pan
Forearm trough
Anatomic bars
Thumb post
Thumb trough
Blocks

9. C-bar

10. Connector bar

11. Cross bar

12. Cuff or Strap

13. Deviation bar

14. Pan and Thumb trough

15. Forearm trough

16. Anatomic Bars
Hypothenar Bar
Lumbrical Bar
Metacarpal Bar
Opponens Bar

17. Thumb Post

18. Blocks

19. Static Orthoses
Classified as therapeutic orthoses
For support and positioning of weak or paralyzed upper
extremities
Used to prevent contractures and further deformity
Can also serve as a platform for other therapeutic
attachments
Classified into levels of involvement:
WHO: Wrist-hand orthosis
HdO: Hand orthosis
EO: Elbow orthosis
SEWO: Shoulder-elbow-wrist orthosis
SEO: Shoulder-elbow orthosis

20. Static Hand Orthosis
Maintains the functional position of the hand and
prevents development of deformities.
Serves as a vehicle for other therapeutic attachments
Patient Population:
Patients with weakness or paralysis of the hand intrinsic
musculature and strong wrist extensors
Without this orthosis these patients are at risk for
developing flat hand with the thumb carpometacarpal
joint in extension
The C7 neurosegmental level quadriplegic exhibits this
weakness

21. Finger Orthosis ( PIP )
 Static Three point
orthosis for boutonniere
deformity

23. Finger Orthosis ( DIP )
Type
 Static or dynamic
Region
 Volar or dorsal
 Joint crossed
Function
Static Volar
DIP Extension Splint

25. Static WHO
Supports the wrist joint, maintains the functional
architecture of the hand, and prevents wrist-hand
deformities.
Patient Populations:
Severe weakness or paralysis of the wrist and hand
musculature.
Prevention of contractures or deformities
Often used for post CVA or C1-5 Quadriplegics with zero
wrist extensors and an intrinsic minus hand

26. Hand Orthosis
Static Dorsal
Hand Orthosis
With an MCP
Block

27. Hand Orthosis
Universal Cuff

28. Wrist Cock-Up Splint (WHO)
Maintain the wrist in the neutral or mildly extended
position
Immmobilizes the wrist while allowing full MCP
flexion and thumb mobility

29. Wrist Cock-Up Splint (WHO)
Contraindications:
Active MCP synovitis
Joint inflammation resulting to volar subluxation
and ulnar deviation
Disadvantages:
Interferes with tactile sensibility on the palmar
surface of the hand
Dorsal strap can impede lymphatic flow

30. Dorsal Wrist Cock-Up Splint
Stronger mechanical
support of wrist and
freeing up some of the
palmar surface for
sensory input
Distributes pressure over
the larger dorsal wrist
surface area
Better tolerated by
edematous hand

34. Special Considerations
For burns: make adjustments as bandage bulk
changes
Preventing infection: when open wound has
exudates, clean splints with warm soapy water,
hydrogen peroxide, or rubbing alcohol
Patients in the ICU: use sterile materials; follow
protocol of the facility
RA patients benefit from thin thermoplast
( less than 1/8 inch )

35. Thumb Spica Splint (WHO)
Help stabilize CMC, MCP and IP joints
Thumb
Post
•VolarVolar
•DorsalDorsal
•RadialRadial
GutterGutterOpponen
s Bar

37. Static Elbow Orthoses
Shoulder slings Humeral Fracture Brace

38. Static Elbow Orthoses
 Designed for reducing soft tissue contractures.
 Must be custom designed and custom fabricated with cuffs and straps.
 Application of low magnitude, long duration forces is preferable for reducing
contractures.
 Contracture reduction should be done slowly and incrementally in a therapeutic
setting.
Patient Populations:
 Can result from trauma or disease
 Largest population affected is SCI who depend on full ROM of the elbow to
propel a wheel chair or bring the hand to the face

39. Static Shoulder Elbow Orthoses
 Commonly seen for support of a painful shoulder or traumatized brachial
plexus-injured limb for long term use as opposed to simple sling.
 The coupling between the forearm trough and the iliac cap can be customized
to permit a variety of motions for the glenohumeral joint.
 Common examples include: “gunslinger,” forearm trough, or shoulder
abduction orthosis.
Patient Population:
 Brachial Plexus injury
 Painful or subluxing glenohumeral joint
 Intrinsic plus hand and wrist C7-8 Spared
 Can have a an WHO extension if weak hand/wrist

41. Shoulder Elbow Wrist Orthosis
 Frequently prescribed to protect soft tissues or to prevent contractures
of soft tissues or to correct an existing deformity.
 Can be utilized for static placement or designed to allow for maximum
mobility.
 These orthoses also known as a shoulder stabilizer or airplane
orthosis.
Patient Populations:
 Post rotator cuff repairs
 Anteroposterior capsular repairs
 Post-manipulation
 Axillary burns

42. Airplane Splints

43. DYNAMIC SPLINTS /
FUNCTIONAL SPLINTS

44. Purpose of Splinting: DYNAMIC
 Protects and assists weak musculature
to perform selective tasks
 Often uses internal or external power
sources to achieve increased
functionality of upper limb
 Often used for patient populations
with long standing limitations who
would benefit from increased function
of hand through use of orthoses

45. Physiologic Considerations
Too great stretch
 Fatigued
 injury
 Failure
Too little stretch
 Atrophy and weaken
 Skin, tendons, ligaments,
and joint capsules will
shorten in the absence of
habitual tensile forces
• Enough stretch
– Three degrees of gain in ROM per week, with a range
of 1-10 deg, is acceptable (Cummings et al 1992 )
– High intensity short term stretching actually promotes
stiffness
– The client should sense tension in the tissues but feel
no pain

46. Guidelines for Dynamic Splinting
Hepburn, 1987
The stretch should not be perceived as a “stretching”
force until at least 1 hour has passed
Client should remain comfortable with the orthosis
for up to 12 hours
After removal, the client should feel no more than a
stiffness or mild ache

47. Basic Components
Outrigger
Dynamic Assist
Finger cuff
Reinforcement bar
Fingernail attachments
Phalangeal bar/finger pan

48. Outrigger

49. Dynamic Assist
Springwire finger coils
Springwire knuckle bender
Elastic bands

50. Finger Cuff

51. Reinforcement Bar

52. Phalangeal Bar/Finger Pan

53. Dynamic Splints
Dynamic finger extension splint
Dynamic wrist extension splint
Tenodesis training
Dynamic ulnar nerve splint

54. Dynamic Finger Extension Splint
Dynamic radial nerve splint
Objectives:
 Immobilize the wrist in functional
position
 Passively extend the MCP to 0
 Permit full active MCP flexion
and unrestricted IP motion
Indications:
 Paralysis of wrist, MCP, Finger
extensors
Advantages:
 Relatively has a less obtrusive
shape as compared to the
outrigger design

55. Finger Cuff
Dorsal Forearm Trough
Dynamic Springwire Assist

56. Dynamic Wrist Extension Splint
Objectives:
 Passively extends the
wrist while allowing
wrist flexion
 To prevent contracture
of unopposed,
innervated wrist
flexors
Indication:
 Weak or paralyzed
wrist extensors

57. Metatarsal Bar
Dynamic Springwire
Knucklebender Assist
Volar Forearm Trough

58. Tenodesis Training Splint
Rehabilitation
Institute of Chicago
Objectives:
 To train tenodesis
grasp
 To promote a strong
tripod pinch with wrist
extension
 Allows finger opening
with wrist flexion
Indication:
 C6 quadriplegia with
grade 3 strength of
wrist extensors

59. Finger Cuff
Thumb Spica
Forearm Cuff
Dynamic Elastic
Band Assist

60. Dynamic Ulnar Nerve Splint
 Dynamic anti-claw
deformity splint, Wynn
Perry Splint
 Objectives
 To passively flex the 4th
and 5th MCP’s
 To prevent shortening of
the MCP Collateral
ligaments
 To promote active IP
flexion
 Indication
 Ulnar nerve lesion

61. Metacarpal Bar
Dynamic
Springwire
Knucklebender
Assist
Lumbrical Bar

62. Capener Splint
Dynamic spring wire splint
for PIP extension
Objectives:
 To passively extend the
PIP
 Allows active IP flexion
 Provide stability to PIP
 Promote restabilization of
lateral bands and prevent
rupture of the central slip
Indications
- PIP flexion contracture
- PIP dorsal dislocation
- Volar plate injury
- Flexor tendon repair with
resulting PIP flexion
contracture
- Partial or complete tear
of the collateral ligament
- Boutonniere deformity

63. Thermoplast
Dynamic
Springwire Finger
Coil Assist

64. General Precautions
Be aware of and make adjustments
for pressure areas
Check for presence of edema
Timing
Compliance
Skin reactions

65. RECENT EVIDENCES
Merete Hermenn et al.,in his randomised trial in 2014
conclude that soft prefabricated orthosis seems to have an
immediate pain-relieving effect during it use, but no effects
in terms of less hand pain, or improved strength or activity
performance when not worn in CMC joint OA subjects.
Natasha A.Lannineinet et al., in her pilot study proved that
saebo flex device is newer technology which is useful in
stroke patient with little or no hand movement in 2016.

66. Bijan forogh et al.,(2012) in his research found that new
design orthosis can significantly relieve pain, improve
function, increase pain threshold and grip strength after
application. This orthosis seemed to be more effective than
counterforce orthosis in relieving pain and increasing the
pain threshold probably due to limitation of forearm
supination.

67. Ibrahim M. et al., 2013, conclude that use of a static
progressive stretch device in combination with traditional
therapy appears to have beneficial long-term effects on
shoulder range of motion, pain and functional outcomes in
patients with adhesive capsulitis of the shoulder. At 12-
month follow-up, the experimental group had continued to
improve, while the control group had relapsed.

68. REFERENCES
 UPPER LIMB ORTHOTICS - ACTIVE CARE PHYSIOTHERAPY CLINIC ©2018
 H. Richard Lehneis, orthosis and prosthesis, Vol.31, No. 4, PP. 14-20, dec. 1977
 D E L I S A ’ S physical medicine & rehabilitation PRINCIPLES AND PRACTICE 5th E D I
T I O N
 Hermann, M., Nilsen, T., Eriksen, C. S., Slatkowsky-Christensen, B., Haugen, I. K., &
Kjeken, I. (2014). Effects of a soft prefabricated thumb orthosis in carpometacarpal
osteoarthritis. Scandinavian journal of occupational therapy, 21(1), 31-39.
 Lannin, N. A., Cusick, A., Hills, C., Kinnear, B., Vogel, K., Matthews, K., & Bowring, G.
(2016). Upper limb motor training using a Saebo™ orthosis is feasible for increasing task‐
specific practice in hospital after stroke. Australian occupational therapy journal, 63(6),
364-372.
 Forogh, B., Khalighi, M., Javanshir, M. A., Ghoseiri, K., Kamali, M., & Raissi, G. (2012).
The effects of a new designed forearm orthosis in treatment of lateral
epicondylitis. Disability and Rehabilitation: Assistive Technology, 7(4), 336-339.
 Ibrahim, M., Donatelli, R., Hellman, M., & Echternach, J. (2014). Efficacy of a static
progressive stretch device as an adjunct to physical therapy in treating adhesive capsulitis
of the shoulder: a prospective, randomised study. Physiotherapy, 100(3), 228-234.

69. THANK YOU