Splints for stroke and neurorehab
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Therapeutic Air Splints for Children - an aid to rehabilitation
|Splints available for
- The child below knee splint
- Single chamber 20 cm
|REF 74 120 0
- The child leg extension
- single chamber splint
- three lengths: --> 40 cm
|REF 74 140 0
|--> 50 cm
||REF 74 150 0
|--> 60 cm
||REF 74 160 0
- The child leg gaiter
- double chamber splint three lengths:
- --> 30 cm
|REF 74 230 0
|--> 40 cm
||REF 74 240 0
|--> 50 cm
||REF 74 250 0
||The baby arm single chamber splint four lengths
No zip fastener on this 14 cm
(Not being made at present time)
|--> 20 cm
||REF 73 020 0
|--> 30 cm
||REF 73 030 0
|--> 40 cm
||REF 73 040 0
- The baby leg extension single chamber splint
- Three lengths 25 cm
|REF 73 125 0
|--> 35 cm
||REF 73 135 0
|--> 45 cm
||REF 73 145 0
- The child arm single chamber splint
- --> 20 cm
|REF 74 020 0
|--> 30 cm
||REF 74 030 0
|--> 40 cm
||REF 74 040 0
|--> 50 cm
||REF 74 050 0
||The child hand splint double chamber 14 cm
No zip fastener
(Not being made at present time)
Therapeutic pressure splints for children have
now been developed in response to the large number of requests from therapists
in various parts of the world who are currently working with children.
This interest was aroused when therapists
found that patients with post stroke disabilities could achieve a high level of
rehabilitation when following a concept of treatment pioneered by Margaret
Johnstone* involving the use of orally inflated splints.
More recently the use of these air splints has
increased and spread to other neurological conditions with the development of
adult therapeutic splints. Now the latest development has considered children's
How or why do these splints work?
They are made of a unique and specially developed PVC-sheeting, were pioneered by Margaret Johnstone, and have been
developed by URIAS. The PVC-sheeting moulds readily to the shape of the
The splints are orally inflated - warm air from the human lungs ensures a perfect fit, softening and so assisting the
moulding of the inner sheath to the patient's limb to give all over even
- A thin cotton sleeve is applied to the patient's limb to be worn while the splint is in use as a protection
against sweat rash.
- The all over even pressure offered to limbs when the splints are correctly applied will maintain inhibiting patterns
and may be used to control tonal flow and associated reactions.
- The stability offered to a limb in this way is sufficient where appropriate to allow weight bearing on a correctly
positioned base and movement within the splint.
The all over even pressure, supplied by the splint plus its stabilising effect on a limb which allows for early
weight bearing makes a valuable contribution to recovery by stepping up sensory input.
- Johnstone M. - Restoration of Normal Movement after Stroke, 1995, Churchill Livingstone.
- Johnstone M. - Home Care for the Stroke Patient, 1996, Churchill Livingstone.
- Johnstone M. - Home Care for the Stroke Patient, (CLIP-Ex Soft Ware).
Contact: Churchill Livingstone Publisher
- (in UK, Europe)
- Harcourt BracL Customer Services
- Footscray High Street, Sideup, Kent DA 14 5HP, UK
- Tel. +44 (0) 18 1 308 5700 Fax: +44 (0) 181 309 9353
- (in USA)
- W B Saunders Customer Services
- 6277 Sea Harbour Drive, Orlando, Florida 32887
- Tel. 001 407 345 2000 Fax. 001 407 352 3395
The splints must be orally inflated. - warm air from the
lungs ensures a perfect fit, moulding the splint to the patients limb to
give all-over even pressure. Pressure should never exceed 40 mm Hg.
Pressure should be read when the limb is at rest.
- A thin cotton sleeve should cover the patients limb while splint is
in use as a protection against sweat rash.
- The splint should not be worn in direct sunlight. Strong sunlight
through the plastic can produce burns of the skin.
No splint should be left on for more than one hour but should be taken off and
reapplied during a full morning treatment session. Splints should never be used for overnight positioning.
Sometimes a patient may have broken skin or a sore on a part to be covered by the splint.
Splints may still be applied but if wound dressings are bulky, reduce the size leaving a smaller sterile
dressing covering the affected area. After use the splint should be, cleaned
as described on page 4. In this event, patients must have their own personal
splint, clearly named and not used on other patients.
- Dispose of splints by normal household rubbish bin. Do not burn on
domestic fire or an electric incinerator.
Care of Splints
Before using for the first time, new splints should be
inflated with the zip fastener open to ensure the two layers of plastic
separate. After fully inflating the splint, the valve should be opened and
the splint rolled up to force all the air out. The splint is then
straightened and is ready for use.
When not in use, the splint should be unfolded and kept
lying flat, or hung up so that the inflation tube hangs downwards, ensuring
that there is no strain where the tube joins the splint. DO NOT USE THIS
JUNCTION AS A HANDLE WHEN FITTING THE SPLINT.
The splints may be wiped over with a mild disinfectant to
clean them, and then dried with a towel. If necessary the valve may be
disconnected and washed and the inflation tube cleaned with a test tube
brush dipped in a mild disinfectant, allowed to dry and then reassembled. DO
NOT let fluid run inside the splints as it cannot drain out.
Splints SHOULD NOT be stored in sub-zero temperatures. The recommended storage
temperature is + 10oC.
For best results, splints should be allowed to achieve treatment room temperature before use.
- Many patients prefer to have their own splints and when appropriate, carers
and family members may be taught to use the splints by the therapist.
- A personal detachable mouthpiece for inflation, easily fitted to the inflation tube, is recommended.
Inflation of Splints
The splints must be orally inflated - warm moist air from the lungs ensure a
perfect mould of the splint to the patient's limb, giving all-over even
Inflation pressures should not exceed 40mm Hg. If in doubt then check the
pressure of the splint with a manometer, using a 10cm connection between valve
on splint and manometer. Pressures should be read when the limb is at rest. **
See below. Pressures comfortable for the patient should always be used.
Therapists quickly become accustomed to the feel of correct pressure. A personal
detachable mouth piece for inflation, easily fitted to the inflation tube and
carried in the user's pocket, is recommended. * See below.
|Mouth Pieces for Inflation
|1. mouth Piece
||REF 75 000 0
|2. filter bottle
||REF 75 011 0
- MOUTH PIECE - a personal detachable mouth piece, easily fitted and carried
in the user's pocket. May be washed and cleaned for frequent use.
- DISPOSABLE FILTER BOTTLE - contains crystals which absorb excess moisture.
Easily fitted to the inflation tube and when detached carried in the user's
pocket. The colour of the granules turn from orange to white (clear) when saturated. Should be discarded when the crystals become white.
** Manometer for Checking Inflation Pressure
To monitor oral inflation pressures, use the Air Splint Manometer 300mm Hg,
Product code 038q,obtainable from:
- A.C. Cossor & Son (Surgical) Ltd., Accoson Works, Vale Road, London N4 1
- Telephone: +44 (0) l 81 800 1172 Fax+44 (0) l 81 809 5170
* NOTE: As illustrated here the fingertips are too near the end of the splint. They must be well back from the end of
If a shorter splint is used to stabilise an elbow with the
hand extending beyond the splint during an exercise session, care must be taken
to ensure that the splint is only left on for a maximum time of twenty minutes.
This also applies to any splint used to stabilise the knee with the foot
protruding. Should longer time be required in this situation the splint should
be taken off and then re-applied.
Therapeutic Arm Splint
Applied most usually
with the patient supine and comfortably supported. The splint should be applied
so that the limb is held in the correct position to inhibit excessive tone.
- A thin cotton sleeve is first put on the patient's limb.
- Pictures A, B and C illustrate the easiest
method used to apply an arm splint.
- The splint is then inflated by mouth. It should be firmly
inflated but must not be overinflated. The pressure offered to the limb must
never exceed 40 mm. Hg. See note below.
Leg Extension Splints
Special Feature: These splints have a non-inflatable weight bearing sole.
Applied to one or both legs with the patient standing or lying supine and comfortably supported as
necessary. The patient should wear full-length cotton stockings or light weight
trousers. Properly fitting shoes or boots should be put on the patient before
the leg is placed in the open splint. The heel of the shoe or boot is then
placed firmly into the heel section of the splint and held there while the zip
fastener is closed and the splint inflated. While inflating, the zip fastener
should be held forward from the front of the knee joint so that with full
inflation the knee is cushioned all round with air.
Uses: A treatment aid for patients who will benefit from standing.
The resulting ankle and foot stability, combined with knee support, allows for the training of standing
balance and stabilisation of the trunk. In the severely disabled will help to
maintain length and pliability of muscles and ligaments and prevent flexion
contracture. Correct standing will inhibit developing spasticity.
Note: When fitting the Leg Extension Splint and the Below Knee Splint
the toe of the shoe or boot may not be fully enclosed in the splint, this is not thought to be a problem as
the shoe protects the toes from any change in pressure. Use an inflation
pressure that is comfortable for the patient and never exceed 40 mm. Hg. If in
doubt check pressures with a manometer, using a 10cm connection between valve on
splint and manometer. Pressures should be read when the limb is at rest.
Therapists quickly become accustomed to the feel of correct pressure.
These splints are intended for training
sessions only and should not be used for more than thirty minutes at a time. If
more time is required the splints may be taken off and then reapplied.
When the ankle and foot are stable the
training for standing balance and the control of trunk and pelvis may best be
done with support from the Leg Gaiter. This double chamber splint fits
high on the leg and supports the pelvis under the ischial tuberosity. A gaiter
may be applied to each leg when the pelvis needs to be fully supported.
Shoes and Boots to be worn with splints must be chosen
with care to ensure there are no sharp parts that would damage the splints.
The Below Knee Splint
This is the shortest of the leg extension splints. It is intended
for use on the lower leg and therefore is termed the Below Knee Splint.
Applied to the lower leg below the knee and the method of application
is illustrated in Fig. A above. This shows the patient's heel, in a properly
fitting boot, placed well back into the heel section of the splint. Before inflation
takes place the therapist grasps the fabric of the splint, as shown in the
illustration, and lets this grasp go gradually as air is blown into the splint.
This ensures a firm cushion of air over the anterior aspect of the ankle and
dorsum of the foot, thus maintaining the necessary stable foot position.
Uses: Mainly to stabilise the ankle and foot giving a
suitably firm base. I while training of sitting balance is undertaken and 2,
while advancing into the next stage of rehabilitation and standing balance is beginning
The Leg Gaiter
This is the second two-chamber splint, again
designed to bring in a specific response. It should be understood that single
chamber splints were designed to give all over even pressure which is used to
maintain inhibiting patterns with stability. It is necessary for the therapist
to understand the response he/she requires in the individual patient if he/she
is to use the splints correctly to assist in the required exercise routines if
progress is to be made. Therein lies the skill of the therapist. Three gaiters
of different lengths are available. 'The smaller sizes are straight
sided but the larger size is tapered towards the foot. When applied to a leg the
top of the splint must be up under the ischial tuberosity. If the child is too
tall for the 50cm length, the longer length of 60cm may be ordered from the
adult range of splints. Adult splints also offer a gaiter length of 70cm.
The patient should wear full-length cotton stockings or light-weight trousers.
Properly fitting shoes are optional. There are two distinctly
different ways in which the leg gaiter can be applied and each method gives a
different response. These are as follows:
Where legs lack stability in extension.
As already described the leg gaiter is a double chamber splint which
will be applied to one or both legs with the patient lying comfortably
supported on his/her back. Applied with the zip fastener down the
lateral side of the leg. The splint is wrapped round the leg and the zip is
closed. The splint is positioned well up the leg so that the top is just
under the ischial tuberosity. The anterior section of the splint is
inflated first to give firm support with the knee in extension. The
posterior section is inflated next to give all-round stability. The foot
protrudes at the foot of the splint. Depending on the need of the patient a
second splint is applied to the second leg in the same way. Most useful
where feet are already stable enough to allow for weight bearing. The
patient is lifted into a standing position.
Where excessive extensor tone is found in one or both legs.
Here it is easier to obtain the required response from the
splint application if it is put on while the patient is standing suitably
supported. Applied as before with the zip fastener running down the
middle of the lateral side of the leg so that, when inflated, the two
sections give clearly defined anterior and posterior pressures on the limb.
This time the posterior section must be inflated first. Where the
patient is standing the position of the foot is extremely important and
should not be allowed to turn outwards. It must have the great toe pointing
straight forwards or slightly inwards to ensure that the weight bearing leg
above is correctly positioned to maintain the position which will inhibit
extensor tone. As the splint is inflated the patient's weight is transferred
over this correctly positioned foot and the knee is encouraged (by the
therapist if necessary) TO BEND into mild flexion. With a firm pressure in
the posterior section of the splint, the anterior section is inflated
minimally to stabilise the knee in the semi-flexed position and to give
Note: that applications 1 or 2 may be done in lying or
standing as long as the therapist obtains the specific required response. As illustrated
earlier, leg A is using the gaiter on a leg that lacks stability in extension
while leg B is using a gaiter on a leg where it is necessary to inhibit
excessive extensor tone.
Uses: dictate the method of application. Some of the uses suggested:
- For practice in weight transfers from side to side.
- In training trunk stability in e.g. Cerebral Palsy.
- To give necessary support to practise side stepping.
- To give necessary support to stand firmly on both feet and
practise knee bending and stretching within the splints.
- To give limb stability in standing while training standing
balance in post-operative rehabilitation e.g. derotational osteotomy.
Gaiters may also be used when the tone in
the hip abductor and leg flexor muscles is so great that standing is
impossible. The gaiters are then applied to the supine patient. The anterior
chamber inflated first, then the posterior chamber to give all round
stability. This induced relaxation will free the hip for passive/active
range of movement, thus maintaining length and pliability of muscles and
soft tissues. Hopefully the child may then progress to standing.
Treatment time with the splints on is limited to an exercise
session of twenty to thirty minutes.
As the foot is not included within the splint
but protrudes beyond, the splint should not be left for longer. If more time is
required the splints may be taken off and then reapplied.
The URIAS Orally Inflated Therapeutic Splints for Children
These splints are now seen by many therapists
as a valuable aid to rehabilitation in neurological damage both in adults and in
children e.g. brain damage resulting from direct violence, stroke, or the
neurological damage associated with M.S., C.P., etc. They have also been found
to be useful in some orthopaedic conditions, e.g. for preventing or stretching
contractures, stabilising joints, mobilising hands etc. They have proved their
worth because of their ability to hold limbs in recovery patterns, maintaining
stability, controlling spasticity and allowing a motor retraining programme to
develop along the same lines as the motor development of the infant. They
increase sensory input and are particularly valuable to the mentally handicapped
and children with visual impairment who have little or no body image or spatial
awareness. This increase in sensory input is frequently necessary if
rehabilitation is to progress. Also, the extra stability offered by the splint
assists weight bearing techniques to give a positive sensory input through joint
The infant rolls before he crawls, crawls
before he kneels and kneels before he stands; he also, rolls before he sits and
sits before he stands. This represents the developmental sequence used in
balance training and the whole sequence, or some part of the sequence, will be
included in the rehabilitation of neurological damage. It is generally agreed
that trunk stability must be the initial aim as limbs cannot be rehabilitated on
an unstable trunk. To work on the trunk where there is no limb stability will
usually increase abnormal tonal patterns in the limbs and, in many cases,
standing remains impossible on unstable limbs. URIAS splints can deal very
effectively with this problem.
The splints act as a valuable rehabilitation
tool which is offered to the skilled therapist. The success of the treatment
frequently depends on the skill of the therapist. She/he must base work routines
on sound neurological principles and splints must be correctly applied, combining
carefully corrective positioning with an advancing exercise programme.
These splints are now marketed in various
sizes from infant (baby) up to adult but this booklet is concerned with sizes
from infant up to teenage. Pages 1 to 2 illustrate the whole range of splints
available and they are marketed under the headings of BABY or CHILD. When
ordering state BABY or CHILD and the length required. All measurements shown on
Pages 1 & 2 are in centimetres and refer to the length of the splint. Select
the appropriate size for your patient. The smallest CHILD splint (Arm) can be
used also as a hand splint (single chamber) or an elbow support splint depending
upon the size of the child. Large children may require small splints from the
ADULT range. The total range of splints can accommodate a wide variety of sizes.
NOTE: For sound neurological reasons, some of these
splints are not designed or suitable for the
treatment of stroke disability, in particular the CHILD extension splints.
Therapeutic splints should not be confused with those which are specifically
offered as an aid to stroke rehabilitation. Therapists may apply to Maersk
Medical for the separate instruction booklets, on Adult Therapeutic Splints and
on Stroke Rehabilitation Splints.
Summary of Points to Remember
- For the debilitated patient a very soft inflation may be
all that is required for a splint to control a limb position. The first
priority must always be to use an inflation pressure that is comfortable for
- If a short arm splint is being used to stabilise an elbow
with the wrist and hand protruding beyond the splint, care must be taken to
ensure that the splint is not left on for an extended period, In this
situation the splint should only be left on while active exercise is carried
out. In the clinical field this has been safely used for periods of up to 20
minutes. Should longer time be required the splint should be taken off and
- The Leg Gaiter
a) Standing: The purpose of the gaiter is to fit high on the
leg so that the ischial tuberosity is weight bearing on the upper edge of the
splint (or splints if two gaiters are applied). This support to the pelvis
facilitates pelvic and trunk stabilisations and allows re~education (or, in
the very young patient, first time learning) of weight transfers and balance
control in preparation for walking.
b) Lying: Gaiters may also be applied to the supine patient
(see earlier, Note 6). The resulting relaxation means that free hip movements
will be facilitated as will rolling. Rolling may be spontaneous or assisted
allowing progression through the developmental patterns that are so often
denied to the disabled child. With increasing ability the child may progress
- The Leg Extension Splint.
a) Standing: The extension splint will support the legs and
give stability where knee, ankle and foot control is lacking and the trunk is
weak. The patient is supported in standing. Extension of the limb
maintained and body weight, directed by posture within the splint, is directed
through the foot which will in turn reinforce the reflex extensor thrust.
Standing balance may be trained and the patient will hopefully progress to
b) Lying: When the patient is unable to stand the extensor
splint may be used to inhibit spasticity in hip abductor and leg flexor
museles to prevent the development of contractural deformities. May also be
used as an aid to rolling as an alternative to the Leg Gaiter (see Note 3b
- Provided the therapist applies the splints using correet
neurological principles many ways may be found to achieve a high standard of
rehabilitation for the patient.
- Splints are comfortable in use and treatment sessions are
welcomed by the patients.
Note: For further information on URIAS Air Splints,
similar booklets to this are available from Maersk Medical:
(1) Therapeutic Air Splints -an aid to rehabilitation (Adult).
(2) Stroke Rehabilitation Air Splints (Adult).
(3) Therapeutic Air Splints for Children ~ an aid to rehabilitation.