Empi

Range of motion limitations, or contractures, can result from a variety of orthopedic or neurologic conditions. Dynamic splinting has proven effective in restoring normal mobility to maximize function and strength, and improve patient outcomes.

Mechanism of Dynamic Splinting

A contracture occurs when connective tissue such as ligaments, tendons, and joint capsules become scarred, or when muscle tissue becomes shortened. This can occur at any joint. Rather than providing a quick stretch which may not be maintained with elastic tissue, a low-load, prolonged stretch (LLPS) evokes a plastic change in tissue length.

Studies show that range of motion gains are maximized when tissues are held at a constant state of mild end-range tension for a minimum of one hour. Early intervention during the fibroplastic stage (1-3 weeks post-injury) with LLPS is most effective in restoring range of motion. ^1-4  

The goal of dynamic splinting is to stress scarred or shortened connective tissue with a LLPS to promote non-traumatic, more permanent tissue remodeling. The lengthened tissue leads to range of motion gains.

Clinical Application

Dynamic splinting may be applied to patients with limited range of motion resulting from connective tissue changes secondary to orthopedic or neurological conditions:

• Orthopedic   
• Neurologic*
• Trauma or surgery  
• Stroke
• Post-surgery joint stiffness 
• Spinal cord injury
• Ligament or tendon repairs 
• Cerebral palsy
• Joint replacement  
• Closed-head injury
• Post fractures   
• Long-term immobilization
• Burns

*Dynamic splinting is contraindicated for patients with moderate or severe spasticity.

Use of Dynamic Splints

Dynamic splinting may contribute to a reduction in rehabilitation time and costs because it is an adjunctive, at-home therapy that enhances therapy received in the clinic. The patient generally wears the device while sleeping or at rest.

A dynamic orthosis uses a tension spring that is integrated into a brace, usually at the mechanical hinge. The spring provides mild, long duration stress on the restricted joint to facilitate tissue remodeling. The tension spring can be adjusted for more or less tension to achieve range of motion goals.

The dynamic splint should feature adjustable struts, cuffs, and pads to reduce pressure points and provide a comfortable fit for the patient. Simple fitting and adjustment controls should be integrated in the device, eliminating the need for tools. Applying and removing the orthosis should be easy for the patient.