The provision of upper limb splints and orthotics is common practice in spinal injury units to maintain range of movement.
Upper limb orthotic devices, for example splints or kinaesthetic tape, are a well-accepted therapy for the management of spinal cord injury, particularly in the acute phase of injury. 1,2 They are generally used to minimise or prevent contractures, spasticity and pain through immobilisation, protection and support of the joints, as well as soft tissue.1-3 Joint and muscle contractures can severely impact independence for people experiencing spinal cord injury. For example, elbow flexion contractures greater than 25 degrees significantly affect a person ’s ability to transfer and complete depression lifts for pressure relief.4-6 Although orthoses are widely used, few studies have investigated the efficacy of splinting for the management of upper limb function following spinal cord injury.7
Not all people are discharged with an upper limb splint and instead may be discharged with a passive range of movement program. Most people need to be assessed on an individual basis and reviewed if there are any changes in their hand, for example if contractures start to develop.
Splints commonly prescribed
- In most cases people with a C4 lesion and above will have a resting hand splint at night. This splint is designed to prevent contractures and maintain cosmesis. It places the hand in a position of rest or function. It is also often worn by people at night with C5 and C6 lesions.
- For most people with a C5 lesion, who have weak or no active wrist extension, a wrist cock-up brace is used during the day to stabilise the wrist and thus increase function. These can be commercially available splints or a custom-made leather or thermoplastic splint.
- People with a C7 lesion often require a metacarpophalangeal blocking splint (anti-claw) to prevent hyper extension of the metacarpophalangeal joints resulting from poor intrinsic function. The splint is worn during the day. These splints are custom made using a thermoplastic material.
- Thermoplastic writing and typing splints may be prescribed. Contact a spinal unit to request a pattern. A range of splints are also commercially available if required.
- Wheelchair gloves or push mitts prevent skin breakdown and may be essential for effective wheelchair propulsion. These can be padded bicycle gloves, or commercially available wheelchair gloves from health product suppliers. A person with tetraplegia may find that commercial supplied gloves are not suitable however as the thumb position can affect a tenodesis grasp. Individual assessment is essential.
Clinical guidelines and information
- Consortium for Spinal Cord Medicine. Preservation of Upper Limb Function Following Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals [pdf]. Washington DC: Paralyzed Veterans of America; 2015 [cited 21 March 2021].
- Consortium for Spinal Cord Medicine. Preservation of Upper Limb Function: What YOU Should Know - A Guide for People with Spinal Cord Injury [pdf]. Washington DC: Paralyzed Veterans of America; 2008 [cited 21 March 2021].
- Curtin M. Development of a tetraplegic hand assessment and splinting protocol. Paraplegia. 1994 Mar;32(3):159-69. DOI: 10.1038/sc.1994.29
- Krajnik SR, Bridle MJ. Hand splinting in quadriplegia: current practice. Am J Occup Ther. 1992 Feb;46(2):149-56. DOI: 10.5014/ajot.46.2.149.
- Paternostro-Sluga T, Stieger M. Hand Splints in Rehabilitation. Crit Rev Phys Rehabil Med. 2004 01/01;16:233-56. DOI: 10.1615/CritRevPhysRehabilMed.v16.i4.10.
- Bryden AM, Kilgore KL, Lind BB, et al. Triceps denervation as a predictor of elbow flexion contractures in C5 and C6 tetraplegia. Arch Phys Med Rehabil. 2004 2004/11/01/;85(11):1880-5. DOI: 10.1016/j.apmr.2004.01.042.
- Dalyan M, Sherman A, Cardenas DD. Factors associated with contractures in acute spinal cord injury. SSpinal Cord. 1998 Jun;36(6):405-8. DOI: 10.1038/sj.sc.3100620.
- Grover J, Gellman H, Waters RL. The effect of a flexion contracture of the elbow on the ability to transfer in patients who have quadriplegia at the sixth cervical level. J Bone Joint Surg Am. 1996 Sep;78(9):1397-400. doi: 10.2106/00004623-199609000-00016.
- Spinal Cord Injury Research Evidence Team. The SCIRE Project. Orthoses [Internet]. Vancouver: Spinal Cord Injury Research Evidence Team; 2020 [cited 5 March 2021].