presented by Deborah A. Schwartz
Dynamic wrist orthoses that allow specific patterns of motion and block unwanted motion can be extremely beneficial in certain diagnoses and rehabilitation protocols, such as scapho-lunate ligament injuries. And static progressive and/or dynamic orthoses can help clients regain lost wrist joint motion after trauma or injuries have caused joint capsule shortening and stiffness. Therapists require core knowledge in upper extremity anatomy and clinical pathologies and an understanding of the biomechanical principles of orthotic fabrication in order to select the appropriate mobilization orthosis as an intervention for clients requiring mobilization of their wrist joints. Therapists also need hands-on practice to make well-fitting and appropriate dynamic and/ or static progressive orthoses for a variety of diagnoses affecting the wrist. They require awareness of pattern-making guidelines and the fabrication process using thermoplastic materials and advanced knowledge of appropriate dynamic and static progressive outrigger systems to aid in their orthotic design.
Deborah A Schwartz is a hand therapist with over 34 years of experience as a practicing clinician. She has worked at Orfit Industries America for the past ten and a half years promoting product awareness and offering a variety of educational programming on orthotic fabrication. Debby is an active member of the American Society of Hand Therapy (ASHT) and has participated in the International Federation of Societies of Hand Therapy (IFSHT) meetings as well. She has presented on a variety of hand therapy topics at both national and international conferences and has written a number of articles for hand therapy publications, including the Journal of Hand Therapy, the British Journal of Hand Therapy, HAND, www.exploringhandtherapy.com, and OT Practice. Debby completed her Doctorate of Occupational Therapy at Rocky Mountain University of Health Professions. She presently teaches orthotic fabrication workshops for Orfit Industries America for both student Occupational Therapists and advanced clinicians. She is also an adjunct professor at the Occupational Therapy department of Touro College in New York City, where she teaches orthotic fabrication and an elective on Hand Therapy. Debby is currently writing several book chapters for hand therapy references and collaborating on a textbook of orthotic fabrication.
This chapter will review basic anatomy of the wrist, including the arrangement of the carpal bones, carpal bone kinematics and the significance of the scaphoid in wrist movement patterns. The chapter will briefly discuss clinical conditions of the wrist and their complications that might benefit from orthotic fabrication of mobilization orthoses.
This chapter will introduce the viewer to a dynamic wrist mobilization orthosis used pre- and post-operatively for clients recovering from a scapho-lunate ligament sprain and/or following a scapho-lunate ligament repair. The Dart Thrower’s motion is the functional motion of the wrist, incorporating wrist extension and radial deviation moving towards wrist flexion and ulnar deviation. The Dart thrower’s motion appears to limit extensive motion at the proximal carpal row, (specifically between the scaphoid and adjacent lunate bones) and therefore preserves the scapho -lunate ligament while allowing for restricted, yet protected, wrist motion. The Dart Thrower’s motion orthosis is a dynamic orthosis that allows this pattern of wrist extension with radial deviation moving towards wrist flexion with ulnar deviation. The dynamic orthotic fabrication techniques of making this complex orthosis in a simple way along with the relevant rehabilitation protocol will be covered. The chapter will highlight the pattern making process, fabrication steps, important guidelines for adding outriggers and checking the correct fit, and precautions for the use of dynamic orthoses.
This chapter will introduce the viewer to a static progressive orthosis used to help regain passive range of motion in the wrist in both directions of flexion and extension. Wrist injuries often result in decreased active and passive wrist motion. A review of the relevant and related anatomy is included. A discussion of the fabrication steps and techniques along with a proposed wearing schedule will be outlined. The chapter will cover the pattern making process and full fabrication steps will be demonstrated. Important guidelines for the outriggers, checking for the correct fit, and precautions for the use of static progressive orthoses will be included in the discussion and video.