Splinting can be a helpful treatment technique for spinal cord injury survivors that experience residual difficulty with hand function. After a spinal cord injury, the upper extremities may become weak or paralyzed, specifically with regard to the hands. If left unmanaged, further complications can develop which decrease overall ability to return to a prior level of function. Fortunately, hand splints are an option for spinal cord injury treatment that can help prevent deformity and promote optimal recovery.
There are a variety of hand splints that can be used to treat individuals with spinal cord injuries. Below we have listed the most effective and commonly prescribed by therapists. Before reviewing the list, let’s take a look at the benefits of using hand splints to treat a spinal cord injury and the process of determining the best splint option.
How a Spinal Cord Injury Can Affect Hand Function
A spinal cord injury can affect many different functions of the body, including motor movement of the upper extremity. For example, damage to the spinal cord can result in paralysis or immobility, depending on the severity and level of injury. The level of injury refers to the location along the spinal cord where damage has occurred. This is the lowest region where full movement and sensation remain.
If the injury was complete, meaning the spinal cord was fully severed, there is no movement or sensation below the level of injury. If the injury was incomplete, it means the spinal cord was partially severed and there is still potential for the neural pathways to have partial function.
Individuals may experience paraplegia (paralysis of the lower limbs) or quadriplegia (paralysis of the upper and lower limbs) after a spinal cord injury. In severe cases, survivors with a cervical spinal cord injury may experience partial or full loss of motor control and sensation in their arms, trunk, and legs.
To compensate for weak or paralyzed muscles of the upper body, survivors can use hand splints for spinal cord injury. Hand splints help support the integrity of the joints by maintaining their alignment and reducing any potential damage to various connecting structures, such as muscles, tendons, and connective tissues.
Splints also helps maintain the normal appearance of the hands by supporting proper positioning. However, to accomplish this, hand splints must be molded to fit the arches and creases of an individual’s hands.
For example, the hands of a survivor with quadriplegia may be more prone to overstretching, stiffness of joints, tightening of tissues, or developing joint contractures due to impaired motor function. Fortunately, wearing proper hand splints after a spinal cord injury can help control and prevent further injury or serious deformities.
Types of Hand Splints for Spinal Cord Injury
A splint is an orthotic device that can be used to protect, support, immobilize or position an injured hand. Splints can either be dynamic, meaning they allow movement, or they can be static which means they are in a fixed position.
A splint can be recommended by a physician or a rehabilitation therapist. It is typically formed or fitted by a hand therapist, who is an occupational or physical therapist with specialized training in treating the upper extremity.
Depending on the type of splint, they may recommend wearing it during the day, at night, or for a particular task. To increase understanding of wearing a hand splint after a spinal cord injury, below is a description of commonly used splints and their purpose. Ask your therapist to ensure it is safe and suitable for you.
The best hand splints for spinal cord injury include:
1. Resting Hand Splints
A resting hand splint is the most commonly used hand splint for spinal cord injury. It provides support to the fingers, hand, and wrist. It will be forearm based to allow for a functional position with the wrist stabilized and a slight bend of the fingers. Once molded, straps are placed over the fingers, the thumb to allow for an open web space, and the wrist to keep the splint in place.
The wrist and forearm should be positioned carefully. Clinicians customize splint position based on muscle tone, ability to perform a functional grasp, and remaining active finger motion. A resting hand splint is usually worn throughout the night, with wearing tolerance increasing over a few days.
2. Wrist Splints
The wrist splint is designed to maintain the wrist in a neutral position to protect against developing deformity. The primary goal of a wrist splint is to prevent overstretching of the wrist extensor muscles and provide a stable base of support for completing tasks. They also can be positioned to have the wrist bent slightly upwards (wrist extension), allowing individuals to use their hands with assistive devices and perform activities such as eating, typing, and pushing a wheelchair.
To wear it, place the thumb into the cut-out. Metal struts are usually positioned on both sides of the wrist and the straps must be tightened firmly to hold the position. Clinicians recommend wrist splints to be worn during the day to increase functional activity participation.
3. Tenodesis Splints
Tenodesis grasp and release is a mechanism that most individuals have naturally. When the wrist is bent downwards (flexed), the fingers straighten out and feel loose. When the wrist is bent upwards (extended), the fingers curl up together and form a grip. However, when a spinal cord injury impairs the hands it may affect this natural mechanism.
Tenodesis splints are designed to help tighten the soft tissues of the hands that become loose when the muscles are not working properly. They especially help individuals with wrist extensors who lack mobility in the fingers. Tenodesis splints are worn until the natural movement of tenodesis has been achieved to promote a functional grasp. These hand splints are usually worn at night through an alternating schedule.
4. Short Opponens Splints
Short opponens splints help maintain thumb web space, prevent hyperextension, and promote functional hand position. They are tailored to help individuals who have proper wrist extension but an imbalance between the extrinsic and intrinsic finger muscles. Short opponens splints also help facilitate tenodesis by opposing the thumb and preventing it from overstretching when performing tasks.
5. Long Opponens Splints
Long opponens splints help maintain web space (area between the thumb and index finger) but are used less frequently than other splints. However, therapists may recommend them for specific functional activities while also reminding survivors to be mindful when using long opponens because they can interfere with wheelchair operation.
6. Palmar-Dorsal Splints
After a spinal cord injury, the fingers and/or wrist may increase in tone as a result of the neurological damage. This result decreases the range of motion of the joints in the upper limb. Palmar-dorsal splints can provide the fingers and wrist with a stable stretch. Fingers are placed in the splint first, allowing them to gently stretch as they straighten out. Palmar-dorsal splints are designed to be worn regularly for extended periods of time.
7. Typing Splints
Typing splints are designed to help survivors use a keyboard. Typing on a computer can be challenging after a spinal cord injury, but typing hand splints help stabilize finger positions. Individuals who experience a spinal cord injury can usually remove these splints using their teeth, making them easier to remove without assistance. However, typing splints can only be used on a regular computer keyboard. To use other devices, discuss with your therapist as custom splints may be required.
8. Finger Splints
To use devices more freely after a spinal cord injury, survivors may benefit from using finger splints. These splints help stabilize the fingers while allowing the tips to be used, such as for touch screen smartphones or tablets.
9. MCP Splints
Metacarpal-phalangeal blocking (MCP) splints help to promote proper motion of the finger during functional hand tasks. They help redirect, isolate, and increase active motion in weak or stiff joints. Therapists may recommend MCP splints to block motion in an inflamed joint to help reduce pain.
10. Other Splints
Lastly, there are other hand splints for spinal cord injury that are commonly prescribed by therapists depending on the needs of every individual. This can include more specific splints such as elbow extension splints, elbow pillow splints, anti-spasticity splints, and intrinsic plus or minus splints.
While many hand splints provide similar benefits, it’s important to determine the best fit for you. Consult with your therapist to see what hand splints after spinal cord injury are most suitable for your needs and overall goals. Splints can aid in your spinal cord injury recovery, but require the assistance of other therapies to maximize your chances of restoring function.
Hand Splints Combined with Therapy for Spinal Cord Injury
Hand splints are most effective when combined with therapeutic exercises for spinal cord injury. When a spinal cord injury damages the neural pathways used for communication between the brain and spinal cord, it can impair hand function. While in a complete spinal cord injury there may be no unaffected neural pathways remaining, an incomplete spinal cord injury has potential for regaining movement during rehabilitation.
Existing neural pathways can be strengthened and new ones created with the help of neuroplasticity, the central nervous system’s ability to repair itself. However, neuroplasticity is best activated with high repetition of exercises, or massed practice. The more the central nervous system is stimulated, the more neuroplasticity can create and strengthen neural pathways needed to restore hand function.
Therefore, to improve movement and coordination, survivors must practice high repetition of hand exercises for spinal cord injury. Based on the nature of the spinal cord injury, incomplete injuries can expect to make improvement of hand motion and strength. However, individuals with complete spinal cord injuries may not have the same expectations of recovery, but can still benefit from an exercise program to move their upper extremity through full range of motion. This will maintain joint integrity, decrease joint stiffness, and help to prevent pain or discomfort from immobility.
Your therapist can also provide more guidance on which hand therapy exercises and hand splints are appropriate for you. The more you exercise your hands, the higher the chances of improving mobility and overall hand function.
Choosing the Best Hand Splints for Spinal Cord Injury
A spinal cord injury can impair various bodily functions, including the ability to use your hands. Survivors may experience weakness or lack of mobility in the hands, which limits the ability to perform daily tasks.
Fortunately, hand splints for spinal cord injury are a treatment option to improve these deficits and strengthen your recovery. With an understanding that splinting is most effective with a customized exercise program, please consult with your therapist to determine which splint option is right for you.