Upper limb splinting

Upper limb splinting is a type of intervention where a piece of material supports or restricts the movement of an arm, shoulder, elbow, wrist or hand.

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What is upper limb splinting?

Upper limb splinting is a type of intervention where a piece of material supports or restricts the movement of an arm, shoulder, elbow, wrist or hand.

There are a number of different types of splints (orthoses). Which type practitioners prescribe your child will depend on their specific treatment plan. For example, gloves can 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. It is important to use the splint as advised and follow all parts of the therapy programme.

What are the aims of splinting?

Splinting aims:

• To maintain range of movement or increase use of the affected side
• To reduce increased tightness and stiffness in the muscle
• To stabilise a joint or joints
• To reduce pain
• To improve function or performance
• To improve patterns of movement or alignment, such as holding the arm in a more natural position
• To maintain hygiene and prevent skin damage
• To minimise the possible development of a long term issue or deformity

Evidence of effectiveness

Current clinical evidence to support the use of splinting is limited. There are several smaller studies of poor quality research.

A systematic review (Jackman et.al. 2014) shows that generally splints are not 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 limits in maintaining improvement in function or skills when the child stopped using the splint.

Neither is there much clinical evidence to support the use of specific Lycra orthoses (see below). Study groups tended to be small 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 wearing it.

Does my child need a splint?

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. They may refer you to an orthotist, who will do the assessment instead.

This can be quite a long appointment, which will take into account ability as well as difficulty. 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 adjust to wearing it.

You can buy splints and orthoses privately, but it is essential to have a proper medical assessment.

It can take up to three weeks to receive the splint if made specially, rather than ‘off the shelf’. The splint should be reassessed every four to six months, or more regularly if the child is growing.

What types of splints are available?

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:

Lycra

Made to measure garments, fabricated out of dynamic (elasticated) material such as Lycra. There are several types, including full bodysuits, vests, sleeves and gloves. A different thickness of material and, in some cases, plastic boning can offer more support in a specific area.

Neoprene

A soft, thick material, similar to a wetsuit, which has some stretch to it and you can cut and sew into different designs. Reinforcing with plastic or metal in places can provide extra support.

You can buy these splints ‘off the peg’ from a range of manufacturers.

Thermoplastic

A strong plastic, which when heated up in hot water becomes malleable. This moulds onto the child’s hand or arm.

These offer less flexibility than neoprene and Lycra splints, but greater support. Sometimes they are hinged.

Using the splints

There are a number of reasons why practitioners might recommend a splint, and that will affect how your child uses it. For example:

• Some splints are only for nighttime use.
• Your child might wear one for improving posture or use of the affected limb for eight hours.
• They might use a splint for improving performance only during specific activities or tasks.

Splints tend to be classified as resting splints or functional splints.

Resting splints are for wearing overnight or during rest periods. 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. Your child may use them during therapy sessions to promote specific movements or skills.

In most cases, your child will use the splint at first for a very short period, which increases gradually until they have built up to the prescribed length of time. Splints need to be used as prescribed to be effective.

It can be difficult to adjust 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 battle.

‘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 come around to the idea. Decorating the splint can also help.

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.

Funding for 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 advise you.