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Upper limb splinting is a type of intervention where the movement
of an arm, shoulder, elbow, wrist or hand is supported or
restricted by a piece of material.
There are a number of different types of splints (also called
orthoses), and which type you are prescribed will depend on your
specific treatment plan. For example, gloves can be used to
facilitate straightening at the wrists, rotating of the forearm and
help provide stability to the fingers.
Splints are often used alongside other treatments such as
botulinum toxin (or Botox) and occupational therapy and
physiotherapy, so it is important to make sure that the splint is
used as advised and that all parts of the therapy programme are
Current clinical evidence to support the use of splinting is
limited. There are several smaller studies of poor quality
research. A recent systematic review (Jackman et.al. 2014) shows
that generally splints are not used as a stand-alone intervention,
but that there is some benefit to hand and arm skills, particularly
when used alongside occupational therapy and/or botulinum toxin. It
also highlighted the fact that maintaining improvement in function
or skills was limited when the child stopped using the splint.
There is also limited clinical evidence to support the use of
specific Lycra orthoses (see below). Study groups tended to be
small in size and the types of orthoses used, types of cerebral
palsy in clinical samples and outcome measures used were variable.
It is therefore difficult to make generalisations about their
effectiveness. One study (Elliott C, Reid S, Hamer P, Alderson J,
Elliott B, 2011) indicated that Lycra arm splinting made
significant changes in patterns and range of movement and motor
performance in children with cerebral palsy when used alongside
another therapy for three months.
Other authors have reported benefits in stability of the limb
when it's held closer to the body, when not walking or running for
example, and the child already has some use of the affected limb.
However other studies report difficulties persuading the child to
use the splint, and problems with comfort and toileting while
Your physiotherapist or occupational therapist can assess
whether splinting will be helpful for your child. They will do an
initial assessment, taking specific measurements of posture and
body parts and discuss the fit and use with you and your child. You
may also be referred to an orthotist who will do the assessment
This can be quite a long appointment, which will take into
account ability as well as difficulty, so it is important to think
about what tasks your child finds difficult and what improvements
you want to achieve in the long term. Some therapists use
photographic or video evidence in this assessment. Part of this
process will cover how you should use the splint and get your child
used to wearing it.
You can buy splints and orthoses privately, but it is essential
to have a proper medical assessment.
A survey of professionals working in the field suggests that it
can take up to three weeks to receive your splint if it is being
made specially for your child, rather than being 'off the shelf'.
They generally recommend that the splint be reassessed every four
to six months, or more regularly if the child is growing.
There is a range of splints available, depending on the
individual need. They are available 'off the shelf' but can be made
to measure. Your physio or occupational therapist will be able to
advise you. Splints can be made out of different materials. Some
common types are:
Made to measure garments, fabricated out of dynamic
(elasticated) material such as Lycra. There are several types,
including full body suits, vests, sleeves and gloves. A different
thickness of material and, in some cases, plastic boning can be
added so they offer more support in a specific area.
A soft, thick material, similar to a wet suit, which has some
stretch to it and can be cut and sewn into different designs. They
may be reinforced with plastic or metal in places to provide extra
support. These splints can be bought 'off the peg' from a range of
A strong plastic, which when heated up in hot water becomes
malleable and can be moulded onto the child's hand or arm. These
offer less flexibility than neoprene and Lycra splints, but greater
support. Sometimes they are hinged.
There are a number of reasons why a splint might be recommended,
and that will affect how it is used. For example:
Splints tend to be classified as resting splints or functional
splints. Resting splints are worn overnight or during rest periods,
as they restrict active movement and function. Children can
sometimes wear them in the day if they aren't able to use the
affected hand. Functional splints are worn during the day to
support a child's functional activities, for example to enable them
to grasp toys better, or they may also be used during therapy
sessions to promote specific movements or skills.
In most cases the splint is used at first for a very short
period, which increases gradually until you have built up to the
prescribed length of time. Splints need to be used as prescribed to
It can be difficult to get used to a new splint. They can feel
tight and restrictive. It's worth allowing extra time to put the
splint on and making sure that the process is as relaxed as
possible. There are lots of strategies for getting children to like
their splint more, making them more likely to wear it without a
'Hands Up For Andie', by Brenda Palmer, is a story book
featuring a little girl who has to wear a splint - which may make
it feel more 'normal' for children who have to wear their splint at
school. Putting old splints on teddy bears and dolls can also help
children to get used to the idea. Decorating the splint can also
Read more helpful suggestions on splints on
the HemiHelp Facebook group.
Most children are able to adapt to the splint quite easily, but
if problems continue beyond two weeks it is worth going back to
whoever has provided the splint. There might be a more serious
issue, such as a problem with fit. A small number of families find
it too difficult to introduce or use a splint.
Some hospitals cover the cost of splints and other orthoses
through their budgets, but you may have to apply for funding. In
other cases parents will need to buy the orthosis or splint
privately. The situation varies greatly, depending on where you
live and what you need. Your healthcare team should be able to