Introduction to Neoprene Splinting

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Therapist Pulvertaft Hand Unit Accredited Hand

1 Introduction to Neoprene Splinting Ella Donnison Clinical Specialist (Hand Therapy) Promedics Hand Therapist Pulvertaft Hand Unit Accredited Hand Therapist British Association of Hand Therapists N

2 Introduction to Neoprene Splinting Splinting Overview Determining splint design & fabricating hand splints are extremely important aspects in providing optimal care for persons with upper limb injuries & functional deficits. Therapists must apply knowledge of pathology, physiology, anatomy, psychology, biomechanics, occupation to best design splints to meet individual needs. There are several steps which must be considered when providing a splint including: Theory & Philosophy Evaluation & assessment Planning Implementation Evaluation Therapists must develop the use of clinical reasoning skills to evaluate, treat & when necessary splint. Once knowledge has been acquired the emphasis is on practice in order to develop confidence & competence. Neoprene Neoprene, or Polychloroprene is a family of rubbers that are traditionally produced by polymerization of chloroprene. Invented by DuPont scientists in 1930, neoprene has since been adopted & put into use in many different industries & applications around the world. It is commonly referred to as wetsuit material & is known for its great insulating properties. Neoprene is a man-made latex free rubber. Elasticity Insulation Cushioning Characteristics Rubber is of elastic Neoprene Rubber (neoprene) on its own stretches equally in all directions External laminated fabrics alter stretch Neoprene is a closed cell material. Neither water nor air can pass through Neoprene does not absorb perspiration or moisture Realign &/or maintain joint & ligament profile Gas filled cells provide a cushion between two surfaces, which is particularly effective in reducing sheer stress When stretched, it returns to its original resting length Thickness of neoprene alters elasticity. Thicker materials have greater resistance to stretch providing more support Assessing elastic / stretch of neoprene: Neoprene sheets stretch differently due to the external laminated fabric used. Determining the stretch of the neoprene can help decision making when deciding on the appropriate application. Suggestion: 1. Cut an equal sized strip of the neoprene material along two edges of a neoprene sheet 2. Holding the ends of one strip stretch it as far as possible & measure the distance the strip can be stretched 3. Repeat number 2 for the second strip 4. Mark on the neoprene sheet which side stretches the most

N Neoprene Splints Neoprene has gained popularity throughout the world for its use as a splint material & there are many commercially available splints & supports for all parts of the body.

3 N Neoprene Splints Neoprene has gained popularity throughout the world for its use as a splint material & there are many commercially available splints & supports for all parts of the body. It can also be used to create custom splints. Neoprene offers creative splinting options while providing warmth, compression, comfort & support. Neoprene for custom splinting comprise of an internal latex free rubber layer of various thickness & then external layers laminated to one or both sides. Many types of fabrics can be laminated to neoprene including nylon, terry cloth, loop fabrics (to which sew on hook will fasten too). They are available in a variety of thickness & colours. Advantages & Disadvantages of Neoprene Splints Advantages Neoprene s elasticity allows flexible support Light to resistive support depending on thickness Confirms to underlying bony contours without pressure area fears Provides insulation Allows compression Shock absorbing properties; pad sensitive/vulnerable areas Light weight Can be reinforced with thermoplastic materials Machine washable Provides comfort = compliance Reinforcements can be added Easy to work with without expensive equipment Disadvantages Does not limit motion Can be bulky Hot & not well tolerated in warm climates Page 3

Introduction to Neoprene Splinting Neoprene Splinting Fabrics Name Juraprene Comfortprene Property Latex free neoprene Latex free neoprene Thickness 3.0 mm 3.0mm 1.

4 Introduction to Neoprene Splinting Neoprene Splinting Fabrics Name Juraprene Comfortprene Property Latex free neoprene Latex free neoprene Thickness 3.0 mm 3.0mm 1.6mm Lining Terry like plush lining Terry like plush lining Nylon lining Unbroken loop lining Colours Beige, Black, Red, Blue, Purple Beige, Black, Blue Size 46 x 61 cm 46 x 61 cm 5.1 cm x 3.0 m Laminated fabrics: Terry cloth has a nice feel against the skin & may help when perspiration occurs. Nylon fabric may be preferred for smaller splints as terry cloth layers add bulk. Nylon fabrics allow tighter conformity as it is a thinner stretchy layer. Nylon fabrics are durable & this is the outer layer on wet suits. The unbroken loop lining / loop fabrics that accept hook fastenings are a convenient way to make quick neoprene splints. Wear, Care & Storage of Neoprene Instructions for the wear of the splint should be provided by the therapist & are dependent many things including the diagnosis, reason for provision & the individual. In hot climates & if full time wear is prescribed patients should be advised on hygiene of the area splinted & the splint see below. Neoprene s are machine washable & air dried. Hand washing is recommended with a mild detergent for neoprene splints with glued seams. It is recommended that the area splinted & the splint are washed regularly. Should the seam tape begin to come away from the neoprene it can be re-ironed. Neoprene sheets should be stored flat or rolled loosely. Tightly rolled or folded neoprene will permanently crease. Store in a cool dry place.

N Allergies / Reactions To Neoprene Allergic reactions to neoprene are rare. As there is no latex in neoprene latex sensitive individuals are not at risk.

Patients should be advised to remove the splint immediately should any signs of unexplained swelling, pain, itching or irritation occur.

Stockinette material can be worn under the neoprene as an adsorption layer.

5 N Allergies / Reactions To Neoprene Allergic reactions to neoprene are rare. As there is no latex in neoprene latex sensitive individuals are not at risk. As with any treatment patients should be provided with appropriate guidance on what to do & who to contact should any issues arise. Patients should be advised to remove the splint immediately should any signs of unexplained swelling, pain, itching or irritation occur. The occlusion nature of neoprene can lead to prickly heat causing skin rashes. Inadequate washing & drying of the split & the skin exaberates problems. Stockinette material can be worn under the neoprene as an adsorption layer. Clinical Applications Clinical areas Trauma Rheumatology Neurology Paediatrics Purpose for application Joint stiffness Oedema Hypersensitivity Cold intolerance Support Delicate skin Comfort Pain Step down splint Neoprene Splint Making Equipment required: Iron Ironing mat Cutting mat Scissors Rotary cutter Heat Gun Tape measure Dowel rod Rubber sealant/impact glue Iron-on seam tape Iron-on hook/loop Plain hook Fabric Marker/Chalk Page 5

Introduction to Neoprene Splinting Basic Neoprene Splint Fabrication Tips Splint pattern: making neoprene splint patterns can be more difficult that thermoplastic splint patterns.

This requires the splint maker to develop a feel for the neoprene materials they are using. The general rule is that for less stretchy or thick neoprene cut a larger pattern.

6 Introduction to Neoprene Splinting Basic Neoprene Splint Fabrication Tips Splint pattern: making neoprene splint patterns can be more difficult that thermoplastic splint patterns. The size of the neoprene pattern depends on the thickness & stretchiness of the neoprene material & the purpose of the splint. This requires the splint maker to develop a feel for the neoprene materials they are using. The general rule is that for less stretchy or thick neoprene cut a larger pattern. Cutting of neoprene: ensure that the neoprene is cut squarely so the edges are flat. This is important when the edges need to be abutted / glued together. Neoprene Seams There are several ways to achieve seams with neoprene including: Gluing Taping Sewing Gluing Seams This is the quickest & easiest way. Only the neoprene core itself can be glued together. Glues made specifically for neoprene are more effective but many solvent based contact adhesives can be used. A neoprene with a thickness less than 2mm may need reinforcement of the seam i.e. iron on tape. Gluing instructions: 1. Apply a thin, even layer of glue to both seam edges & allow the glue to dry & become tacky. Abut the edges together. 2. Try the splint on the patient. If adjustments are required, this is the time to do them. Re-gluing a glued seam is impossible. Cut outside the previous seam to create a new edge. 3. After 30 minutes the glued edges are firm but maximum strength is achieved after 24 hours. 4. Reinforce any seams that may undergo stress.

N Taping Seams Heat sensitive iron on tape can be used to create a seam. The seam tapes available are generally a nylon knit with a heat activated polyurethane adhesive coating on one side.

Seam tape can be used on either side of the seam or one side & with or without glue between the core edges. 3.

7 N Taping Seams Heat sensitive iron on tape can be used to create a seam. The seam tapes available are generally a nylon knit with a heat activated polyurethane adhesive coating on one side. These tapes stretch approximately equal in all directions. Taping instructions: 1. Put on seam tape when no more adjustments are required. 2. Seam tape can be used on either side of the seam or one side & with or without glue between the core edges. 3. If one side of the neoprene is laminated with terry cloth or loop; place small pieces of hook fasteners to hold the neoprene pieces in place while applying the seam tape on the opposite side. 4. Cut the tape slightly longer than the neoprene seam. 5. Using an iron on a medium temperature without steam place a piece of paper or thin cotton between the iron & the tape, to keep the melted glue away from the iron plate. 6. Hold the iron with firm pressure during 30 seconds. Do not slide. 7. Let the tape cool, ideally for 24 hours, before stressing the splint. NOTE: The tape can be removed whilst still warm if mistakes are made. Once cool the tape cannot be removed. Small pieces of seam tape can be used to go around curved seams. Sewing Seams Commercially available splints have flat, smooth seams which are achieved by using industrial sewing machines. Seams can however be achieved with home sewing machines. Successful sewing is often dependent on trial & error to identify which works best with the type & thickness of neoprene being used. Fasteners & Straps Hook & loop fasteners are the easiest to use on neoprene splints. There are 3 ways to create fastenings, depending on the neoprene fabric being used: 1. Hook straps attached directly to the loop fabric of the neoprene. a. Easy & fast. b. Loop fabric is less durable than the original loop straps. c. Loop fabric limits the amount of stretch in the neoprene. 2. Hook & loop fasteners sewn to both ends of the neoprene. a. Requires a sewing machine or hand sewing. b. Durable. c. Not as easy to adjust. 3. Hook & loop fasteners glued on both ends of the neoprene. a. Can be applied in locations where sewing is difficult or impossible. b. Do not attempt to fasten/unfasten for minimum of 10 mins. c. Requires about 24 hours curing before it can be stressed fully. d. Take care not to scorch the neoprene if using an iron. Page 7

8 Introduction to Neoprene Splinting References 1. ACPIN (1998) Clinical practice guidelines on splinting adults with neurological dysfunction Association of Physiotherapist Interested in Neurology, London 2. Bailey JM, Cannon NM, Fess EE et al (1992) Splint Classification System American Society of Hand Therapists (ASHT) Chicago 3. Berger S (1995) Personal Communication. In Coppard, B M & Lohman, H (2001) Introduction to Splinting, A Clinical-Reasoning and Problem-Solving Approach. Mosby 4. Charest E (2003) The Paediatric Patient. In Jacobs, M.A & Austin, N.M. Splinting the Hand and Upper Extremity: Principles & Practice Lippincott Williams & Wilkins 5. Colditz JC (1999) Splinting with neoprene, construction tips for custom splinting North Coast Medical Inc. 6. Copley J & Kuipers K (1999) Management of Upper Limb Hypertonicity Therapy Skill Builders 7. Coppared B.M. & Lohman H. (2001) Introduction to splinting: A Critical-reasoning & problem solving approach 2nd ed St.Louis, Mosby. 8. Hogan L, Uditsky T. (1999) Paediatric Splinting: Selection, Fabrication, and Clinical Application of Upper Extremity Splints. The Psychological Press 9. Jacobs M, Austin N (2003) Splinting the Hand and Upper Extremity: Principles and Processes Lippincott Williams & Wilkins, Baltimore 10. Kennedy SM (1996) Neoprene wrist brace for correction of radial club hand in children Journal of Hand Therapy 9: McCormack GL & Feuchter F (1996) Neurophysiology for the sensorimotor approaches to treatment ( In LW Pedretti (Ed) Occupational Therapy: Practical skills for physical dysfunction) pp St Louis: Mosby 12. Simim H (2001) Neoprene splinting North Coast Medical Inc 13. Stern E B et al (1998) Neoprene Splinting: Dermatological Issues AJOT 52(7): Twist DJ (1985) Effects of wrapping technique on passive range of motion in a spastic upper extremity Physical Therapy 65 (3): Wajon A (2000) The thumb strap splint for dynamic instability of the trapeziometacarpal joint Journal of Hand Therapy, 13:236-7

9 Notes Page 9

10 Notes Page 10

11 Patterns Page 11

12 Patterns Promedics Orthopaedics Ltd. Port Glasgow Industrial Estate Gareloch Road, Port Glasgow Scotland PA14 5XH Telephone: +44 (0) Sales Fax: +44 (0) General Fax: +44 (0)

O Orficast. Introduction to Orf icast TM. Ella Donnison. Splinting by Promedics.

O Orficast. Introduction to Orf icast TM. Ella Donnison. Splinting by Promedics. Introduction to Orf icast TM Ella Donnison Clinical Specialist (Hand Therapy) Promedics Hand Therapist Pulvertaft Hand Unit Accredited Hand Therapist British Association of Hand Therapists www.promedics.co.uk