Toni Thompson, MA, OTR/L, C/NDT and Erica N. Goldin, OTR/L Orthosis Practicum: Gearing Up to Meet Client Needs with Efficient Innovation Presentation Details Basic-introductory and Intermediate-experienced levels.
This interactive experience incorporates tricks-of-the-trade techniques in the fabrication of a wrist-hand immobilization orthosis and a serpentine orthosis. Participants will learn methods to enhance ergonomics, to improve client collaboration in the fabrication process and to use materials economically. The focus on orthosis fabrication offers opportunities for therapists with a wide range of experience and skill levels to participate.
2. Brief Description The participant will:
State the optimal position for the orthosis of the upper extremity in a variety of diagnoses. Make one pattern for one wrist-based orthosis. Demonstrate or state the process to make one orthosis without a physical pattern. Fabricate one wrist immobilization orthosis with one of three hand variation components or one wrist hand immobilization orthosis. Fabricate one serpentine orthosis, either hand-based or forearm-based. Demonstrate three techniques to increase efficiency in orthosis fabrication. Demonstrate three methods of enhanced ergonomics in fabrication process. State three techniques to encourage client collaboration during the fabrication process. Determine essential components of home education to facilitate compliance with orthosis wear. State nine uses for small material scraps. Define five basic infection control standards.
Handouts include patterns and designs for wrist immobilization and wrist-hand immobilization orthoses, and bibliography. PARTICIPANTS: Please bring a pair of SCISSORS for use in orthosis construction. Presenters: Toni Thompson, MA, OTR/L, C/NDT and Erica N. Goldin, MS, OTR /L Toni Thompson, MA, OTR/L, C/NDT, fabricated, modified, or fit over 10,000 upper extremity orthoses during her 22 years at Shriners Hospitals for Children in Tampa. She developed and presented 10 two-day pediatric splinting workshops. As a senior instructor for TherapyEd, she has presented over 150 OT Exam Review Courses throughout the US, including Puerto Rico. Publications include over 40 articles in AOTA, OT Practice, ADVANCE for OTs, Journal of Pediatric Orthopaedics, and a variety of physical therapy and orthotic and prosthetic magazines. She authored a chapter in Culture in Rehabilitation: From Competency to Proficiency. Currently, she continues to teach OT Exam Review courses and provide volunteer service to projects in Tampa and in various Latin American countries.
Erica N. Goldin, Ms, OTR/L, is a 2011 graduate of the University of Florida Master’s program in
Occupational Therapy and holder of the Alice C. Jantzen Fellowship for her class.
Practicum Outline TERMINOLOGY Volar = palmar Dorsal Wrist flexion, not volar flexion Wrist extension, not dorsiflexion CMC, MP, PIP, DIP, IP Index, middle, ring, small fingers Elbow ROM 0 ° to 125 °- 140 º Radial styloid Ulnar styloid Mechanical Properties
! Force ! influence that changes/directs motion.
! Parameters of force ! Nature: type, either push or pull. ! Magnitude: amount. ! line of angle of application: path. ! point of application: location where force acts.
Mechanical Properties ! Torque = moment of force ! The potential for a force to produce:
! rotation of lever around an axis (joint.) ! Torque
! unbalanced force. ! point of application NOT the center of the object. ! resulting in rotation of object around fixed axis.
Mechanical Properties ! Torque = moment of force ! Torque = Force X perpendicular distance from the axis of rotation to the point of application.
LEVERS CLASSIFICATION SYSTEM American Society of Hand Therapists (ASHT) CLASSIFICATION SYSTEM ARTICULAR = cross joint(s.) NON-ARTICULAR = do not cross joint Support/protect bone/soft tissue. CLASSIFICATION SYSTEM LOCATION = JOINT(S) WHERE orthosis ACTS WRIST = functional orthosis. WRIST/HAND = positional orthosis. THUMB = hand-based thumb orthosis. THUMB CMC/MP = forearm-based, IP free. WRIST/THUMB = forearm-based thumb. ELBOW = elbow orthosis. CLASSIFICATION SYSTEM DIRECTION = DESIRED POSITION
Flexion Extension Pronation Supination Radial Ulnar Palmar Abduction Opposition Static Orthosis components are essentially immobile. immobilize joint(s.) block one joint for movement elsewhere. facilitate dynamic function. immobilize joint for function later. position for function. Serial Static Orthosis or cast elongate tissue maintain joints, soft tissue, muscle, tendon in lengthened fashion. worn for lengthy periods of time to prevent rebounding. modified periodically by therapist. Static Progressive Orthosis
! low-load force. ! on maximum ROM. ! non-elastic elements for stress. ! variable adjustment to increase ROM.
Dynamic Orthosis static base outrigger & elastic components. controlled mobilizing force & elastic component. passive-assistive ROM or active-resistive ROM. CLASSIFICATION SYSTEM DESIGN DESCRIPTORS Forearm-based Hand-based Thumb-based Digit-based Arm-based Radial Ulnar Dorsal Posterior Volar Anterior CLASSIFICATION SYSTEM Volar wrist/hand extension immobilization = positional orthosis. Volar wrist extension immobilization = functional volar orthosis. Wrist thumb opposition immobilization = long opponens orthosis. TYPES OF ORTHOSES Functional Enhance current function. Allow thumb/finger movement. Wrist-finger dynamics. TYPES OF ORTHOSES Positional
Prevent current functional movement. Continuous low load pressure. Enhance/maintain position. Increase function after orthosis removal. Prevent deformity. Positional or Functional WRIST ORTHOSES???? Wrist-finger dynamics ROM Immobility VS. Mobility Stability & Sleep position Tenodesis, Tone GOALS OF ORTHOSIS USE Facilitate functional movement. Enhance positions of function. Immobilize joint(s) for function. GOALS OF ORTHOSIS USE
! Enhance gains made in therapy. ! Substitute for therapy.
GOALS OF ORTHOSIS USE ! Inhibit tone/stiffness. ! Support joint laxity. ! Support low tone.
GOALS OF ORTHOSIS USE ! Position pre-operatively. ! Rest/position post-op site. ! Rest post-injury.
GOALS OF ORTHOSIS USE ! Prevent/decrease pain. ! Prevent/decrease contractures. ! Prevent/decrease deformities.
GOALS OF ORTHOSIS USE ! Decrease inflammation from injury. ! Decrease arthritic inflammation. ! Substitute for muscular weakness.
GOALS OF ORTHOSIS USE ! Substitute for motor impairment.
! Substitute for muscular imbalance. ! Substitute for muscular weakness.
CONTRAINDICATIONS MOVEMENT IMPAIRMENTS
! Athetosis ! Ataxia ! Dystonia
SENSATION LIMITATIONS CONTRAINDICATIONS MEDICAL CONDITIONS
Tone/stiffness Static & dynamic contractures Sensation ORTHOSIS ASSESSMENT FUNCTIONAL SKILLS Fine motor skills Self-care skills School activities Leisure activities Chores ORTHOSIS ASSESSMENT COGNITIVE SKILLS Patient cognition Caregiver cognition Ability to carry out PRECAUTIONS don the orthosis maintain time schedule assess for potential injuries HAND/WRIST POSITION Functional Wrist 20°- 30° MPs 35°- 45° PIP/DIPs flexed 45 ° palmar abduction to opposition Safe, Intrinsic-plus, or Anti-deformity Wrist 30°- 40° MPs70 °- 90° PIP/DIPs extended 40°- 45° palmar abduction to opposition The best position and function I can get! Volar orthosis evenly distribute pressure on volar forearm and wrist/hand immobilize wrist free digits for function WRIST EXTENSION IMMOBILIZATION ORTHOSIS options Thumb free
! allow thumb CMC, MP, and IP function Short thumb support
! immobilize thumb CMC and MP ! allow active IP function
Long thumb support immobilize thumb CMC, MP, and IP RADIAL or ULNAR IMMOBILIZATION ORTHOSIS “GUTTER ORTHOSIS”
Functional with elbow free fingers & thumb free for function short thumb post to stabilize MP long thumb post to stabilize MP & IP Positional with elbow included WRIST/HAND IMMOBILIZATION ORTHOSIS Prevent/decrease contractures Enhance function after orthosis removal CUSTOM THERMOPLASTIC WRIST HAND IMMOBILIZATION ORTHOSIS Long thumb post support webspace immobilize CMC, MP, & IP prevent IP hyperextension CUSTOM THERMOPLASTIC ORTHOSIS Fabrication LAB ERGONOMICS Posture. Cutting. Smoothing edges: Use table edge, Use heel of hand, Use leg. THERMOPLASTIC WRIST EXTENSION IMMOBILIZATION ORTHOSIS Key Fabrication Tips distal palmar crease free attention to bony prominences therapy putty bevel padding THERMOPLASTIC WRIST EXTENSION IMMOBILIZATION ORTHOSIS Key Fabrication Tips place damp paper towel on skin use damp paper towel over dressing fit on my wrist first fit on my finger first THERMOPLASTIC WRIST EXTENSION IMMOBILIZATION ORTHOSIS Key Fabrication Tips trough 2/3 length of forearm trough 2/3 width of forearm adequate thenar eminence clearance CUSTOM THERMOPLASTIC WRIST/ HAND IMMOBILIZATION ORTHOSIS Key Fabrication Tips trough 2/3 length of forearm trough 2/3 width of forearm CUSTOM THERMOPLASTIC WRIST/ HAND IMMOBILIZATION ORTHOSIS Key Fabrication Tips fit to wrist first adequate thenar eminence space
CUSTOM THERMOPLASTIC WRIST HAND IMMOBILIZATION ORTHOSIS Key Fabrication Tips next, fit to forearm stretch webspace and thumb area appropriate thumb position finger pan 1/2 height of fingers CUSTOM THERMOPLASTIC WRIST HAND IMMOBILIZATION ORTHOSIS pan angle MP angle MP bend STRAPS Contour Feather PADDING STRAPS Self-adhesive pads Removable pads Back-to-back adhesive hook Velcro WRIST EXTENSION IMMOBILIZATION ORTHOSIS Thumb & Webspacer options
! Theratube ! Foam Roll
Velcro Options Imbed Hook Velcro Imbed Loop Velcro Thermoplastic rivet RED MARKS DO NOT USE PADS OR MOLESKIN TO PAD TIGHT ORTHOSIS OPENING! Make opening larger
! Cut down orthosis around prominences ! Heat & expand orthosis over bony areas
Mold with therapy putty on bony areas Cut hole and bevel pad at risk areas SERPENTINE ORTHOSES HAND-BASED SERPENTINE Inhibits thumb-in-palm position Supports MP Long thumb post stabilizes MP stabilizes IP Short thumb post stabilizes MP allows IP function FOREARM-BASED SERPENTINE Rigid webspace support Minimal wrist support Short thumb post stabilizes thumb MP
allows IP function SERPENTINE ORTHOSIS Fabrication LAB ORTHOSIS EDUCATION Educate Demonstration/Documentation Understanding Contact information Activity checkout Time schedule Issues Other priorities Notice RED FLAGS EDUCATION Educate
Repair toys/toilets/blinds Splints for stuffed animals and toys CO$T CUTTING TIP$ DON’T RECYCLE SPLINTS between clients. Modify child’s own splints only. Keep scissors sharp and clean. Use separate scissors for velcro. Sew only regular velcro--not adhesive back--on sewing machine. CO$T CUTTING TIP$ Recycle new knee immobilizer pads. Use a fry pan or microwave. Use pure water. Clean splint pans well. Use a high-wattage hair dryer. Have caregivers make cloth splints. Try feasible low-tech options first. INFANT FITTING HINTS Engage the child. Have caregiver hold, cuddle child. Allow child to have a bottle. Sing. Make baby noises. Breathe softly and slowly. Assure caregiver that behavior is normal. TODDLER FITTING HINTS Engage the child. Sing. Dance. Be silly. Make funny faces. “Help me, please!” “Pick the color you want!” Explain each step in simple words. Give positive feedback. OR….. School Age & Adolescent Tips Use team or school colors for straps. Decorate with fabric paint. Add thermoplastic sun, heart, or other design. Apply stickers. Imbed stones or jewels. Decorate with permanent markers. INFECTION CONTROL Determine strategies and policies: Cleaning pans. Changing water. Wearing gloves. Re-dipping thermoplastic splints. Fitting prefab splints.
Bar, K. (1994). The use of air bags to increase supination and pronation in the arm. American Journal of Occupational Therapy, 48(8). Barr, N.R., & Swan, D. (1988). The hand: Principles and techniques of splinting the hand. (2nd ed.). Boston: Butterworth Heineman Publishers. Beatty, E., Light, T.R., Belsole, R.J., & Ogden, J.A. (1990). Hand clinics, the pediatric upper extremity.Philadeplphia, PA: W.B. Saunders. Bell, E., & Graham, H.K. (1995). A new material for splinting neonatal deformities. Journal of Pediatric Orthopedics, 194,68-73. Bleck, E.E. (1987). Orthopedic management in cerebral palsy. Philadelphia: Lippincott. Buck-Gramko, D. (Ed.). (1998). Congenital malformations of the hand and forearm. London: Churchill Livingstone. Callinan, N.J., & Mathiowetz, V. (1996). Soft versus hard resting hand splints in rheumatoid arthritis: Pain relief, preference, and compliance. American Journal of Occupational Therapy, 50 347-354. Cannon, N.M. (January 1991). Diagnosis and treatment manual for physicians and therapists (3rd Ed.) Indianapolis: The Hand Rehabilitation Center of Indiana, P.C. Cannon, N.M., Foltz, R.W., Koepfer, J.M., Lauck, M.R., Simpson, D.M., & Bromley, R.S. (1985). Manual of hand splinting. New York: Churchill Livingstone. Carmick, J. (1997). Case report: Use of a neuromuscular electrical stimulator and a dorsal wrist splint to improve hand function of a child with spastic hemiparesis. Physical Therapy, 77(6): 661-671. Case-Smith, J., Allen, A.S., & Pratt, P.N. (2001). Occupational Therapy for Children. (4th ed.). St. Louis: Mosby. Casey, C.A., & Kratz, E.J. (1988). Soft splinting with neoprene: the thumb abduction supinator splint. American Journal of Occupational Therapy, 42(6), 395-398. Chakerian, L., & Larson, M. (September 1991). The effects of upper extremity weight bearing on hand function in children with cerebral palsy. NDTA Newsletter. Clark, G.L., Wilgis, E.F., Aiello, B., Eckhaus, D., & Eddington, L.V. (1997). Hand rehabilitation: A practical guide (2nd.ed.). New York: Churchill Livingstone. Colditz, J., Principles of Splinting and Splint Prescription Retrieved August 2012: http://www.handlab.com/articles/splint_chap.pdf. Collier, S.E., & Thomas, J.J. (2002). Range of motion at the wrist: A comparison study of four wrist extension orthoses and the free hand. American Journal of Occupational Therapy, 56(2). Collins, L.F. (October 1996). Splinting survey results. OT Practice, pp.42-44. Coppard, B.M., & Lohman, H. (2001). Introduction to splinting: A clinical–reasoning and problem-solving approach. (2nd ed.). St. Louis: Mosby. Currie, D.M. & Mendiola, A. (1987). Cortical thumb orthosis for children with spastic hemiplegic cerebral palsy. Archives of Physical Medicine and Rehabilitation, 68, 214-216. Dell, P.C., & Dell, R.B. (1996). Management of rheumatoid arthritis of the wrist. Journal of Hand Therapy,9(2), 157-164. Diffendal, Jill (2000). Splinting for brachial plexus surgeries, ADVANCE for occupational therapy practitioners, September 11, 32. Doubilet, L., & Schiff Polkow, L. (May-June 1977). Theory and design of a finger abduction splint for the spastic hand. American Journal of Occupational Therapy, 31,5, 320-322. Duvall-Riley, Beverly. (1998). Big goals for little kids and splints. ADVANCE for occupational therapy practitioners, April 13.
Duvall-Riley, Beverly. (1998). Managing tone in little hands. ADVANCE for occupational therapy practitioners, April 20. Exner, C, & Bonder, B. (1983). Comparative effects of three hand splints on bilateral hand use, grasp, and arm-hand posture in hemiplegic children: A pilot study. Occupational Therapy Journal of Research, 32, 75-92. Falconer, J. (1991). Hand splinting in rheumatoid arthritis. Journal of Hand Therapy, 4(2), 81-86. Falkenstein, N., & Weiss, S. (1999). Hand rehabilitation: A quick reference guide and review. St. Louis: Mosby. Fess, E.E. (2002). A history of splinting: To understand the present, view the past. Hand Clinics (16)4:579-595. Fess, E.E., & McCollum, M. (1998). The influence of splinting on healing tissues. Journal of Hand Therapy, 11, 157-160. Fess, E.E., & Philips, C.A. (1987). Hand splinting: Principles and methods (2nd Ed.) St. Louis: Mosby. Fess, E.(2005). Hand and Upper Extremity Splinting: Principles and Methods (3rd Ed.) St. Louis: Mosby. (with pass code to online website.) Flatt, A.E. (1994). The care of congenital hand anomalies (2nd ed.). St. Louis: Quality Medical. Flegle, J., & Leibowitz, .M. (1998). Improvement in grasp skill in children with hemiplegia with the MacKinnon splint. Research in Developmental Disabilities, 9(2), 145-151. Glenn, M.D., & Whyte, J. (Eds.) The practical management of spasticity in children and adults. Malvern, PA: Lea & Febiger. Gompf Russell, T. (1984). Effects of serpentine splinting on reducing thumb in palm position. Unpublished masters’ thesis. Miami: Florida International University. Goodman, G., & Bazyk, S. (1991). The effects of a short opponens thumb splint on hand function in cerebral palsy: a single subject study. American Journal of Occupational Therapy, 45(8), 726-731. Goodman, S. (1998). A closer look at the many faces of JRA. ADVANCE for occupational therapy practitioners, November 2. Goldberg, B., & Hsu, J.D. (1997). Atlas of orthoses and assistive devices (3rd ed.). St. Louis: Mosby. Gordon A, & Duff SV. (1999). Relation between clinical measures and fine manipulative control in children with hemiplegic cerebral palsy. Developmental Medicine & Child Neurology Sep;41(9):586-91. Groth, G.N., & Wulf, M.B. (1994). Compliance with hand rehabilitation: Health beliefs and strategies. Journal of Hand Therapy, 8,18-22. Gupta, A., Kay, S.P.J., & Scheker, L.R. (2000). The growing hand, diagnosis ,and management of the upper extremity in children. St.Louis,MO: Mosby. Henderson, A, & Pehoski, C. (Eds.) (2006). Hand function in the child: Foundations for remediation, 2nd edition. Philadelphia, PA: Mosby,Inc. Hogan, L., & Uditsky, T. (1998). Pediatric splinting: Selection, fabrication and clinical application of
upper extremity splints. San Antonio: Therapy Skill Builders. (out of print)
House. J.H., Gwathmey, F.W., & Fidler, M.O. (1981). A dynamic approach to the thumb-in-palm
deformity in cerebral palsy. The Journal of Bone and Joint Surgery, (6-A)2, 216-225.
Jacobs, M., & Austin, N. (2002). Splinting the hand and upper extremities. Baltimore: Lippincott,
Williams & Wilkins Publishers.
Jamison, S., & Dayhoff, N. (1980). A hard hand-positioning device to decrease wrist and finger
hypertonicity: A sensorimotor approach for the client with non-progressive brain damage. Nursing
Kamil, N.I. & Correia, A.M. (1990). A dynamic elbow flexion splint for an infant with arthrogryposis. Physical Therapy 44(5), 460-461. Kennedy, S.M. (1996). Neoprene wrist brace for correction of radial club hand in children. Journal of Hand Therapy12(20):174-177. Kerr, Tom.(1997). Splints and kids: You can make it work. ADVANCE for occupational therapy practitioners, February 17. King, S., Thomas, J.J., & Rice, M.S. (2003). The immediate and short-term effects of a wrist extension orthosis on upper-extremity kinematics and range of shoulder motion. American Journal of Occupational Therapy, (57)5. Langlois, S., Pederson, L., & MacKinnon, J.R. (1991). Hand splints and cerebral spasticity: A review of the literature. Canadian Journal of Occupational Therapy, 56(3), 113-119. Lee, M., LaStayo, P., vonKersberg, A. (2003). A supination splint worn distal to the elbow: A radiographic ,electromyographic, and retrospective report. Journal of Hand Therapy16:190-198. Lin, S.C., Huang, T.H., Lin, C.J., Hsu, H.Y., Chiu, H.Y. (1999). Asiple splintingmethod for correction of supple congenital clasped thumbs in infants. Journalof Hand Surgery(Br) 24(5):612-614. Lindholm, L. (1986). Weight-bearing hand splint: a method of managing upper extremity spasticity. Physical Therapy Forum, 5(3). Lourie, G.M. (1999). Treatment of congenital differences of the upper extremity: Surgeon’s perspective. Journalof Hand Therapy 12(2):164-173. Mackin,E.J., & Callahan, A.D., Osterman, A.L., Skirven, T.M., Schneider, L.H., Hunter, J.M., & Rich, R.R. (Eds.) (2002). Hunter, Mackin, and Callahan’s rehabilitation of the hand: and upper extremity (5th ed.). St. Louis: Mosby. MacKinnon, J., Sanderson, E., & Buchanan, D. (1975). The MacKinnon splint: A functional hand splint. Canadian Journal of Occupational Therapy, 42,157-158. Malick, M.H. (1985). Manual on static hand splinting: New materials and techniques. Pittsburgh: Healthcare Hamarville Rehabilitation. Malick, M.H. (1972). Manual on static hand splinting. Pittsburgh: Hamarville Rehabilitation Center. McKee, P. & Morgan, L. (1998). Orthotics in rehabilitation: Splinting the hand and body.. Philadelphia: F.A. Davis Company. Melvin, J.L. (1989). Rheumatic disease in the adult and child: Occupational therapy and rehabilitation. Philadelphia: F.A. Davis Company. Mercer, N.S.G. (1989). Silicone gel in the treatment of keloids. British Journal of Plastic Surgery, 42 83-87. Murphy, M. (1990). An adjustable splint for forearm supination. American Journal of Occupational Therapy, 44(10). Neuhaus, B., Ascher, E., Coullon, B., Donohue, M.V., Einbond, A., Glover, J., Goldberg, S.R., & Takai, V. (1981). A survey of rationales for and against hand splinting in hemiplegia. American Journal of Occupational Therapy ,35, 83-90. Osterhout, B.M. (1990). Postoperative splinting of the pediatric upper extremity. Hand Clinics, 6, 693-695. Ouellette, E.A. (1991). The rheumatoid hand: Orthotics as preventative. Seminars in Arthritis and Rheumatism, 21, 65-71. Palmer, P.M., MacEwen, G.D., Bowen, J.R., & Mathews, P.A. (1985). Passive motion therapy for arthrogryposis. Clinical Orthopedics and Related Research, 194, 54-59. Patterson, D.B., & Flanders, M. (1992). The pediatric arch orthosis: A combination splint for weight bearing and prehension. NETWORK, a Bimonthly Publication of the Neuro-Developmental Association. Pedretti, L., & Early, M.B. (2001). Occupational Therapy: Practice Skills for Physical Dysfunction (5th ed.). St. Louis: Mosby.
Permer, C.A. (Ed.). (1996). Surgery of the hand and upper extremity. New York: McGraw-Hill. Reid, D. (1992). A survey of canadian occupational therapists’ use of hand splints for children with neuromuscular dysfunction. Canadian Journal of Occupational Therapy, 59(1). Reyman, J. (1985). The sof-splint. Developmental Disabilities Special Interest Section Newsletter, 8(2). Rose, V. & Shah, S. (1987). A comparative study on the immediate effects of hand orthoses on reduction on hypertonus. Australian Journal of Occupational Therapy, 34(20), 59-64. Sala, D.A., Rosenthal, D.L., and Grant, A.D. (1996). Early treatment of an infant with severe arthrogryposis. Physical and Occupational Therapy in Pediatrics, 16(3), 73-89. Sanford, D. (2009). Effectiveness of Wrist and Hand Splinting for Increasing Recovery of Individuals Post-Stroke. Pacific University. Retrieved August 2012. http://commons.pacificu.edu/cgi/viewcontent.cgi?article=1005&context=otpf Scherling, E., & Johnson, H. (1989). A tone-reducing wrist-hand orthosis. American Journal of Occupational Therapy, 43(6). Schultz-Johnson, K. (1996). Splinting the wrist: mobilization and protection. Journal of Hand Therapy, 9, 165-176. Seiler, J., MD. Flexor Tendon Repair. Retrieved August 2012: http://www.former-surgery.northwestern.edu/plasticreading/Documents/curriculum/Hartigan/Handouts/027%20-%20flexor%20Tendon.pdf Snook, J. (1979). Spasticity reduction splint. American Journal of Occupational Therapy, 33(10). Solie, B. (1978). Short opponens hand orthosis. American Journal of Occupational Therapy, 32,588 Stanley, B.G., & Tribuzi, S.M. (Eds.) (1995). Rehabilitation of the hand: Surgery and therapy (4th ed.) St. Louis:Mosby. Stanley, B.G., & Tribuzi, S.M. (Eds.) (1992). Concepts in hand rehabilitation (contemporary perspectives in rehabilitation, volume 9). Philadelphia: F.A. Davis Co. Stern , E.B., Ytterberg, S.R., Krug, H.E., Larson, L.M., Portoghese, C.P., Kratz, W.N.R., & Mahowald, M.L. (1997). Commercial wrist orthoses: A descriptive study of use and preference in patients with rheumatoid arthritis. Arthritis Care and Research, 10, 27-35. Swigart,C., Eaton, R., Glickel,S., Johnson, C. Splinting in the treatment of arthritis of the first
carpometacarpal joint. (1999). Journal of Hand Surgery, 24(1), 86-91.
Takami, M., Fukui, K., Saitou, S., Sugiyama, I., & Terayama, K. (1992). Application of a shape memory alloy to hand splinting. Prosthetic Orthotics International,16, 37-63. Tenney, C.G., & Lisak, J.M. (1986). Atlas of hand splinting. Boston: Little, Brown & Co. Thompson, T. (2007). Volunteer Opportunities Esperanza Village Health Place Visit. ACPOC News, 13:4, 16-22. Retrieved August 2012. http://www.acpoc.org/library/2007_04_016.asp Thompson, T. (2004). Strategies and techniques to enhance wearing compliance of splints in pediatrics.
ADVANCE for Occupational Therapy Practitioners,May 17, 2004, 14-15. Retrieved August 2012.
Thompson, T. (1999). ‘La Victoria’ makes drawing a reality for one little girl. ADVANCE for Occupational Therapy Practitioners, 12(14), 26. Retrieved August 2012. http://occupational-therapy.advanceweb.com/Article/La-Victoria-Makes-Drawing-a-Reality-for-One.aspx Thompson, T., & Myers, J.C. (1998). Orthotists and OT: An interdisciplinary practice model. ADVANCE for Occupational Therapy Practitioners, Sept. 21, 1998. Retrieved August 2012. http://occupational-therapy.advanceweb.com/Article/Orthotists-and-OTs-in-Pediatrics.aspx Thompson, T., & Malloy, M. (1997). The Computer Access Splint. ADVANCE for Occupational Therapy Practitioners, Dec. 1, 1997. Retrieved August 2012. http://occupational-therapy.advanceweb.com/Article/The-Computer-Access-Splint.aspx
Thompson, T., & Tobin (Chambers), A.B. (1997). The Modified MacKinnon: A low temperature approach to pedi splinting. ADVANCE for Occupational Therapy Practitioners, Dec. 1, 1997. Retrieved August 2012. http://occupational-therapy.advanceweb.com/Article/The-Modified-MacKinnon-A-Low-Temperature-Approach-to-Ped-Splinting.aspx Thompson, T., Smith, S., & Griner, D. Customized Walker Adaptions for a Child with Cerebral Palsy, Pediatric Physical Therapy, Summer 1992. Journal of the Association of Children's Prosthetic Orthotic Clinics, Winter 1992. Thompson-Rangel, T. (September 21, 1991). The mystery of the serpentine splints. OT Forum. (out of print) Trombly, C., & Radomski, M.V. (Eds.). (2002). Occupational therapy for physical dysfunction. (5th ed.). Baltimore: Lippincott, Williams, & Wilkins. Wallen, M., & O’Flaherty, S. (1991). The use of soft splint in the management of spasticity of the upper limb. Australian Journal of Occupational Therapy, 38(15), 227-231. Willey, M.C. (2004). Modification to a pediatric thumb splint. American Journal of Hand Therapy,17(3):379-380. Williams, P.F. (1985). Management of upper limb problems in arthrogryposis. Clinical Orthopedics and Related Research, 194,60-67. Wilson, G. (1997). Custom Neoprene Splints for Upper Extremity Disorders. ADVANCE for occupational therapy practitioners. December 1, 1997. Wilton, J. (2003). Casting, splinting, and physical and occupational therapy of hand deformity and dysfunction in cerebral palsy. Hand Clinics, 19:573-584. Wilton, J.C., (1997). Hand splinting principles of design and fabrication. Philadelphia: W.B. Sanders. Zimmerman, R, Gschwentner,M., Kralinger, F., Arora, R., Gabi,M., Pechla, S. (2004). Long-term results after pediatric distal forearm fractures. Archives of Orthopedic Trauma Surgery 124(3):179-186. Web links: Retrieved August 2012. http://practicalplasticsurgery.org/docs/Practical_28.pdf Tendon Injuries of the Hand. Retrieved August 2012. ffhttp://practicalplasticsurgery.org/docs/Practical_32.pdf
