Patient and Family Education SupER Splint Shoulder External Rotation and Forearm Supination Wrap Why does my baby need a splint? Your baby has been diagnosed with brachial plexus palsy. This causes your baby to have limited active movement of their arm and hand. Recovery of your baby s movements may be slow and cause an imbalance in their muscle strength and flexibility of their joints. This imbalance may cause lifelong changes in your baby s shoulder joint and may impact how they will use their arm in the future. What is a SupER splint and how does it work? You may notice that your baby s weaker arm rests in a thumb-down position while their other arm rests palm- and thumb-up. A special splint called the SupER splint is designed to help your baby keep their shoulder and forearm in the proper positions. It does this by keeping their arm in a thumb-up position ( supination ) and their shoulder in external rotation. By positioning your baby s arm this way, it helps keep their arm muscles flexible while the nerves in their arm heal. How do I put the splint on my baby? Part 1: Thermoplastic arm section and wrap The thermoplastic splint and elastic wrap helps maintain the palm-up position. 1. With the palm facing up, put the splint on the inside of arm/hand. 1 of 5
2. With the palm still facing up, apply the elastic wrap (supination wrap). Starting with the thumb, heart facing, loop around the hand and through the thumbholes twice. 3. Continue to wrap the strapping up over the entire length of the arm splint. 4. Overlap by half of the strap width while wrapping. 5. Apply gentle, even tension as you wrap the splint up your baby s arm. 2 of 5
Part 2: Waist band The waist band and strapping support your baby s outward shoulder position (into external rotation). 6. Put on the waistband just like you would put on a diaper. The waistband should be snug around your baby s waist and pulled up between their legs. 7. Gently turn your baby s shoulder outward with their thumb pointing out. Always position your baby s shoulder with your hands. Do not use the strapping to pull the shoulder into position. 8. Attach the Velcro straps to the top of the arm and elbow, securing to the back of the waistband. 3 of 5
When should my baby wear the splint? Your baby should start by wearing the splint for 22 hours a day. Remove the whole splint twice a day to check your baby s skin. Your baby may have breaks from the splint for bathing, stretching and therapeutic play. Remove the strapping from the waistband to the arm section when your baby is in their car seat. We will check how your baby s movements and shoulder position are doing each month. We will look at your baby s development, arm strength and flexibility to decide when to reduce their splint wearing time. What do I need to watch for when my baby is wearing the splint? Each time you take off the splint, check your baby s skin for redness or irritation. Redness that disappears within 20 to 30 minutes is OK. Check the color of your baby s fingers often. Do this especially as your baby is getting used to wearing the splint. If your baby s fingers are dark purple or white: o This may mean there is poor blood flow to their hand. o Check the strapping to be sure it is not too tight. o Remove the splint right away; allow the color to return to normal and then reapply the splint. o Watch the strapping tightness as you reapply the splint. Contact your therapist if the redness or irritations do not go away, or if there are persistent issues in fit or use of SupER Splint. How long will my baby need a splint? We recommend your baby wear the SupER splint for some portion of the day or night for the first year of their life. We will assess your baby each month to decide the length of time they will need to use the splint. Sometimes an additional splint is needed to increase overhead movements when your baby gets a little older. How do I clean the splint? Wipe the arm splint, where not covered in fleecy web (pink material) daily with a damp, soapy cloth. You can also use an alcohol wipe. Hand wash the waistband and strapping, as needed. Hang them to dry. To wash the waist band, you can also use MiraZyme Odor Eliminator, which you can get from Amazon.com. 4 of 5
To Learn More Brachial Plexus Clinic Scheduling 206-987-2759 Therapy Scheduling 206-987-2113 www.seattlechildrens.org Free Interpreter Services In the hospital, ask your child s nurse. From outside the hospital, call the toll-free Family Interpreting Line 1-866-583-1527. Tell the interpreter the name or extension you need. What else should I know? Don t wait until your next clinic visit to tell us about any problems you are having with the splint. We encourage you to call with questions or problems. The plastic arm section of the splint can lose shape if it is left in a hot car or near a heat source. Be consistent in wearing the splint. Your baby will adjust to the splint more quickly if it is worn regularly. Do stretching and therapy with your baby as recommended. The splint does not replace stretching. If you have any questions or concerns about the wear, care or fit of the splint, call your baby s occupational therapist at 206-987-2759, option 4 (nurses line). Content adapted with permission from BC Children s Hospital, Occupational Therapy Department. Seattle Children s offers interpreter services for Deaf, hard of hearing or non-english speaking patients, family members and legal representatives free of charge. Seattle Children s will make this information available in alternate formats upon request. Call the Family Resource Center at 206-987-2201. This handout has been reviewed by clinical staff at Seattle Children s. However, your child s needs are unique. Before you act or rely upon this information, please talk with your child s healthcare provider. 2018 Seattle Children s, Seattle, Washington. All rights reserved. Occupational Therapy 5/18 PE2404 5 of 5