Would a splint be contraindicated in this case?
November 17, 2008
We all know that one of the purposes of splinting by occupational therapists is for joint protection and to preserve function and range of motion. I have blogged before about my experience with fabricating below knee amputation (BKA) splints, used to preserve knee extension for being able to fit orthoses at a later date.
Sometimes, however, I wonder if a patient really needs the splint. For example, I once had a 85 year old patient who had severe Alzheimer’s dementia, was completely bedbound at a nursing home at baseline and had a BKA due to gangrene. While normally I would make a splint, I wasn’t sure that it was indicated in this case.
First, the patient was bedbound at baseline, and therefore an unlikely canditate for a prosthetic. Second, a patient is very likely to develop skin breakdown and sores from a splint if the splint schedule isn’t adhered to, or frequently monitored. Third, splints aren’t generally the most comfortable things.
Providing a splint would not increase or improve quality of life, and so it would seem to me that a splint would not be indicated in this case for the reasons listed above. What are your thoughts?
Entry Filed under: Ethics, OT, Open Questions, acute care, dementia, hospital, occupational therapy, phys dys, splint. Tags: below knee amputation, BKA, ethical dilemma, orthotoic, prosthetic, splinting.
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1.
sarah | November 18, 2008 at 4:34 am
Oh I’d say definitely contraindicated. In OT we are all about promoting function, and unless the cause of the amputation was the reason she had been bedbound, one would not be expecting that she would regain a higher level of mobility after the amputation. So, like you wrote, the risks are too high to warrant a splint that will not be promoting her function.
2.
Daniel | November 25, 2008 at 2:24 am
Hey, i had splints made for my hands when i was little, the material was like leather at first anmd they traced my hand outline onto it then cut it out, heated it up, wrapped it around my arm and when it cooled it was hard… i was just wondering if you know what it’s called?
Oh and sorry this isnt like a real comment, so yeah, i’d say it’s contradictory =)
Thanks
-Dan
3.
aishel | November 25, 2008 at 11:00 pm
Hi Dan, thanks for your comment. I’m not sure specifically, but perhaps a finger pan splint?
4.
Ciaran O'Hagan | January 10, 2009 at 5:25 pm
I enjoyed reading your comments and as a 3rd Year OT student in the UK I really wonder if Splinting is truly OT – where is the occupation in splinting? Don’t OT’s use activity as their treatment medium and i can see no activity in splinting. I feel this is a job of the Physio. Althought splinting does have benefits, such as protection against contracture, alignment, I feel it is on a par with providing medication which acts to improve a persons health. What do you all feel about OT’s who splint?
5.
Nadia | September 19, 2009 at 3:02 pm
Hi there! May I know which university in UK are you currently in? Thanks.
6.
Ciarán O'Hagan | September 20, 2009 at 4:52 am
I’ve just left Bournemouth University – why did you ask? Just to make you aware that my above comments are my own thoughts and don’t necessarily represent the University’s stance on OTs and hand-splinting….
7.
Nadia | September 21, 2009 at 2:46 pm
Oh nono, please dont get me wrong.. I have no issues with your comments above.. I’m actually an occupational therapy student in my country at a diploma level and I would have to go to either to UK or Australia for a year to obtain a degree hence I’m kinda doing a little research on Universities that offer occupational therapy as a course. yeah.
8.
James Bishop | January 14, 2009 at 8:57 am
I think splinting for perfectally ok for OT’s to do. I think of splinting as a preporatory method, or something that can prepare a pt. for function. Splinting can also improve function, as in the case of a tenodesis splint for someone with wrist drop.
9.
Ciaran O'Hagan | January 14, 2009 at 4:30 pm
I see the point that you’re making but splinting doesnt have an activity as it’s treatment medium – giving medication to ease pain also has the same affect of improving function or prepares people to be more functionally in daily occupations e.g. washing and dressing – so should OT’s train to give out medication?
OT philosophy is to use activity/occupation as our medium of treatment and i feel this differs us from other professions.
10.
Shawn | February 22, 2009 at 10:19 pm
I agree splinting is not necessarily OT treatment however I believe that the OT part of splinting comes from providing education or attempting to incorporate splint wear into daily routines.
11.
robert | August 27, 2009 at 4:17 pm
As for the amputee, consider this scenario (that I recently encountered): a very recent BKA nursing home resident whose knee is contracted at about 90 degrees. This resident is in bed half the day, and in her chair the rest of the time. While in bed, the patient lies supine, which means that the stump is resting directly on the bed. Would splinting be indicated in this case to help treat the contracture so that the terminal end of the leg wouldn’t have direct pressure on it?
12.
aishel | August 27, 2009 at 5:30 pm
Robert, in your case, I think I would adapt a heel elevator (aka waffle boot) to raise the stump off the bed.
13.
dax | October 1, 2009 at 5:24 am
1. you all know what splints are for.
2. true, one of OT’s philosophies is to use activity/occupation to treat our pts.
3. if im not mistaken, i believe that the OT definition from the 8th ed of spackman still applies, which states: OT is the art and science of DIRECTING man’s participation in selected task … however you want to re/direct it through our many approaches/FORS its up to you as long as that task is considered as purposeful to the pt.
4. true, splinting is not an activity in itself but it is an adjustment (adaptation) of an activity that yields to a desired end result thus making it purposeful to the pt. only with a little change with the internal or external mechanism. but isnt PA the foundation where OT is built upon?
5. with regards to the patient cited, i think the purpose for splinting is definitely not the quality of life of the pt but rather to facilitate the efficient delivery of care by the primary caregivers if ROM will be preserved. so long as the wearing schedule is strictly being observed, i think giving her a splint would still be a good decision.