Splint therapy

The role of splint therapy in occupational therapy and adaptation

Splint therapy is considered an essential element of occupational therapy for patients who have suffered a spinal cord injury (SCI). The use of splints, which belong to the category of adaptive and assistive equipment, pursues a clear practical goal — to adapt the person to new conditions, maximize their safety, and expand their level of activity in daily life.

According to clinical guidelines, the use of such adaptive devices has strict indications. They are prescribed in cases where the patient, for objective reasons, is unable to master other methods of physical rehabilitation, or when these methods are physically unavailable. It is important to note that the effectiveness of this approach has an evidence base: the level of evidence (LE) is 5, and the grade of recommendation (GR) is C. In addition to the use of splints, occupational therapy includes targeted training aimed at improving instrumental skills. These skills are critically required by the patient in everyday life, and their training must be based exclusively on the individual needs of a particular patient.

Integration with physical and motor therapy methods

Splint therapy does not exist in isolation; it seamlessly complements basic methods of physical recovery. Extremity therapy for any degree of paresis is used in the early, intermediate, and late recovery periods of SCI (LE 5, GR C).

Key areas of motor therapy accompanying adaptation include:

• Neurodevelopmental PNF (proprioceptive neuromuscular facilitation). This method is integrated into comprehensive therapy with specific targets: increasing muscle strength, training sitting-to-standing transitions, balance training, restoring walking ability and hand activity (LE 4, GR C).
• Strength training. It is indicated in all periods of injury (early, intermediate, late recovery, and residual). Mandatory conditions for its initiation are complete stabilization of the body's main vital functions and good patient tolerance to loads (LE 5, GR C).
• Training for spastic paresis. Focused training of the lower extremities and trunk is recommended. A goal-directed movement technique with a high number of repetitions is used. The main goal is to improve motor control and restore sensorimotor function (LE 5, GR C).

Spasticity management and hardware innovations

To ensure that splint therapy and physical exercises yield maximum results, spasticity must be adequately controlled. As an adjunct to basic physical rehabilitation, spasticity-reducing methods are used to improve daily motor activity (LE 3, GR A). If conservative treatment of regional spasticity proves ineffective, intrathecal baclofen therapy is recommended to reduce spasticity (LE 3, GR B).

The modern approach also involves the use of innovative and hardware technologies:

1. Hardware rehabilitation (exoskeleton). Indicated for extremity paresis and plegia after SCI. The goal is to improve activity in daily living (LE 5, GR C).
2. Virtual reality technologies. Used in the recovery period of SCI in the presence of mild to moderate paresis and/or spasticity. A key feature of the method is that it is used strictly additionally to basic physical rehabilitation methods to improve daily motor activity (LE 3, GR A).

Pain relief

Effective use of splints and adaptive equipment is difficult without adequate pain management. In the presence of neuropathic pain syndrome, a strictly individual comprehensive rehabilitation program must be developed (LE 5, GR C).

Pain management is based on an interdisciplinary approach. To achieve optimal results, combining the following methods is recommended (LE 5, GR C):

• Pharmacotherapy;
• Physical exercise;
• Physiotherapy modalities;
• Psychotherapy.

Class and exam questions

What else to study on this topic

• Diagnostic imaging in blunt abdominal trauma (Abdominal Trauma): choosing between CT and ultrasound.
• Abdominal manifestations of cystic fibrosis (Cystic Fibrosis): from meconium ileus to fibrosing colonopathy.
• Specific and nonspecific influenza prophylaxis: vaccination timing and sanitary measures.
• Neutropenic enterocolitis: ultrasound findings and the risk of cecal perforation.
• Intrathecal baclofen therapy for refractory spasticity unresponsive to conservative treatment.

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.