Volume 4, Issue 2 www.exploringhandtherapy.com February 2004

In This Issue

Click on Index pages to link

Featured Article...............1

Physical Therapyapproved CEU courses...3

EHT CEU courses...........4

Test your Knowledge......6

Splinting Tips & Tricks.....6

Test answers.................10

Ergo Tips.......................10

Website news................12

PDF Bonus Pages 2 pages

From the Editors’ Desk:

Susan Weiss Nancy Falkenstein

Greetings as we begin 2004with great offers and excitinghand therapy education cours-es. As always, EHT is dedicat-ed to bringing hand therapistsexcellence in education. This is our second PDF ( avail-able on the Internet) version ofthis newsletter. This newsletteris made possible by our spon-sors who are dedicated tobringing you quality products.Please visit our sponsors and ifyou are viewing this on thePDF version click anywhere onthe ad and it will link you totheir website. Have fun!

Don't forget, the ideas expressedhere are the views and ideas ofthe authors and contributors (thisincludes you). So remember, toalways consult your referringphysician and clinic managerbefore you implement ideas. EHTis not responsible for ideas print-ed or posted.

NEWS FLASH!!Physical Therapist’s and

Assistants EHT is approved inFL, TX, & OH for CEUs. See

page 3 for details.

Earn all your CEUs with EHT. www.exploringhandtherapy.com

Wouldn't it be great if you couldposition each stiff joint precisely atmaximum tolerated end range withexactly the right amount of tension?Guess What? You can! That is whatstatic-progressive splinting (SPS)does! And, when you choose a typeof component that is infinitelyadjustable such as a turnbuckle orMERiT™ component, you have theadded benefit of infinitely adjustabletension and joint position. SPS isthe technique of choice when youwant to increase passive range ofmotion (PROM). Clinical experiencehas shown that elastic tensionapproaches simply cannot providethe same outcomes in terms ofspeed or amount of progress.

I was trained to use rubber bandsearly in my hand therapy career butintuitively was convinced that static-progressive approaches would deliv-er superior force. I searched for away to replace elastic traction withSPS. In the mid 1980's, while work-ing with a challenging patient, I hadthe "eureka!" experience that led tothe design of the MERiT™ compo-nent. I tried it with many of mypatients and then made it commer-cially available through my company,UE TECH. It has dramaticallyimproved my ability to increase mypatients' PROM. From the corre-spondence and discussions I havehad with therapists all over theglobe, many have shared this sameoutcome.

Hand therapists know that toachieve PROM gains, the stiff jointmust be positioned as close to avail-

able end range as possible andmaintained in this position for a sig-nificant period of time, often severalhours. Elastic tension seems tooffer a sound method to achieve thisgoal. However, the spring or elasticcannot maintain the joint at endrange because it immediatelystresses the joint beyond this posi-tion. While it appears that stressingtissue beyond end range would help

Featured Article: Giving Stiff Joints A Moving

Experienceby Karen Schultz-Johnson

Continue on page 2

Figure 1: Elastic tension splints. An elastic componentcontinues to shorten to the point where it tractions theshortened beyond their current available length. Whilethis may seem desirable, it causes pain and ultimatelycreates micro-trauma and increased scar formation.The end result is decreased PROM.

Figure 1

dynamic Elastic dynamic elastic

dynamicelastic

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gain motion faster, it does not.Tissue stressed beyond its availablelength suffers microtrauma.(Refer tofigure 1). The body responds to thisinjury with inflammation anddecreased PROM. To find an elasticcomponent that takes the joint to theavailable end range, and not beyondit, with just the right amount of forceis difficult if not impossible. The ten-dency will be to either overstress orunderstress the tissue. The result ineither case is either failure toprogress range or very slowprogress.

CONTRASTING STATIC-PRO-GRESSIVE SPLINTING TO OTHER

MOBILIZING APPROACHES

SPS applies torque to a joint viainelastic components in order tostatically position it as close to end-range as possible. These compo-

nents permit progressive joint posi-tion changes as PROM increases

without changing the splint basestructure. The different force genera-tors vary in how they grade tensionand joint position. (See Table One)Static Progressive (SP) splintsrequire angle of pull adjustments asPROM progresses. When appliedcorrectly, the SP splint holds short-ened tissue at its maximum, tolera-ble length and does not stress

continued on page 3

TABLE ONEGRADABILITY OF STATIC-PROGRESSIVE

FORCE GENERATORSThe higher the level of gradability, the morethe patient can take advantage of smallchanges in tissue length and excursion byrepositioning the joint at the new end range.

Infinitely adjustable*Can change the joint position by a fraction ofa degree and torque force by a fraction of agram *Types of SPS components: turnbuckles,*screws, *gears and MERiT™ components

*Potentially infinitely adjustableProgressive hinges have a continuous arc ofmotion and position the joint at any degree ofROM*Physically difficult to progress joint ROM andtorque exactly as desired

Grossly adjustable*Offer approximate adjustment in ROM*Types of SPS components: static line;hook/loop tapes; incremental hinges (changejoint position in 10° to 30° increments)

Figure 2 Static-Progressive splints. SP splints allowadjustable tension and changes in joint position atany time. They place tissue at maximum length anddo not stress beyond it. The patient can immediatelyadjust the splint to capture increased tissue lengthand thus increase PROM.

figure 2

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beyond it (fig 2 page 2). As tissue lengthens in response tothis carefully applied stress, the clini-cian or wearer adjusts the joint posi-tion to progress tissue to the newmaximum tolerable length. Theprocess continues until the patientachieves desired tissue length andROM goals.

In contrast to SPS, elastic tractionsplints create a mobilizing force withself-adjusting resilient or elasticcomponents. Such splints allowactive-resisted motion in the direc-tion opposite of their line of pull. Thetension generated continues as longas the elastic component can con-tract, even when the shortened tis-sue reaches the end of its elasticlimit. While combining elastic com-ponents with inelastic componentsdoes increase the control over forcegenerated, it is not the same as stat-ic-progressive splinting. (Figure 3)illustrates this concept.

Yet another splint approach to increase joint PROM is serial-staticsplinting. While serial-static splintsposition restricted tissue at maxi-mum, tolerable length, the clinicianmust remold the splint to accommo-date increases in tissue length andprogress to greater ROM.

ADVANTAGES OF SPSSo why should you choose SP force

generators? What are the benefitsof this approach to splinting?Because of its unique characteristicsin setting ROM and force, static-pro-gressive splinting has many advan-tages including:**Patient-controlled force**Enhanced splint tolerance**Excellent compliance**Maximum "dose" of end rangetime** Potential for night time wear**Works with soft- or hard-end feeljoints**Removability for hygiene, functionand exercise**Cost-effectiveness

PATIENT CONTROLLED FORCESPS allows the patient the ability toinstantly progress the splint ratherthan waiting for the therapist. Thisresults in rapid gains in PROM asthe patient takes immediate advan-tage of incremental PROM increasesand adjusts the splint for comfort.The patient remains continued on page 9

Attention Physical TherapistsExploring Hand Therapy has been approved for CEU’s in

Texas, Ohio, & Florida for select courses

Figure 3AFigure 3B

figure 3 C

(Figure 3 ABC)While combining elastic componentswith inelastic components does increase the con-trol over force generated, it is not the same as stat-ic-progressive splinting.Figure 3A uses elastic traction via rubber bands.Figure 3B combines rubber bands with hook andloop tape. This still creates elastic tension. Figure 3C uses static-line and hook and loop tape.This embodies true SP traction.

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Ohio Physical Therapy Approved: A Comprehensive Approach to RSD/CRPS of the Upper Extremity 7.5 hoursThe Basics & Beyond: A Comprehensive Study of Hand & Upper Extremity24 hours

Florida Physical Therapy Approved: A Comprehensive Approach to RSD/CRPS of the Upper Extremity 0.85 CEUs

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All of these courses and more are available online atwww.liveconferences.com for viewing 24/7

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1. When accomplishing plasticdeformation of tissue throughstress relaxation; what type ofsplint would you choose?

2. You should only use static pro-gressive splints with a hard end(feel) range. True or False

3. What type of splint appliestorque to a joint via inelastic com-ponents in order to statically posi-tion it as close to end-range aspossible?

4. Name at least three advan-tages of static progressive splint-ing.

5. To provide the optimum

amount of torque force, each jointsplinted will require its own indi-vidual SP component. True orFalse

6. Name at least three static pro-gressive splinting facts accordingto the featured article.

7.Clik-strips is a form of staticprogressive splinting? True or False

8. When fabricating a splint youcan incorporate static progres-sive, serial casting, and/ordynamic splinting in one splint tomeet the needs of the patient.True or false

9. Name three implications ofmobilization splints?

10. What is the general goal orpassive range of motion expectedper week, per joint, when suc-cessful static progressive splint-ing is achieved?

11. When fabricating mobilizationsplints, the therapist should con-sider specific precautions. List 3precautions when dealing withSPS or any mobilization splints.

Answers on page 10

**Static progressive splints canbe fabricated using hinges, turn-buckles, nylon cord, non-elastictape, strapping materials, screwsand any material that is nonelas-tic in order to set the joint posi-tion and tension and achievemobilization.

**The position of anti-deformityplaces the MP joints in the flexedposition and the IP's in extensionand is used to prevent collateralligament tightness. It is also callthe "safe position".

**Always warm material beforecutting it to protect your ownjoints. Just don't get it too hot oryou can overstretch the material.

**An alternative to a hole punch

is a sodering iron to make holesin your splints. This techniquewill save your joints especiallywhen using an older hole punch.

**To obtain smooth edges whencutting make sure your scissorsare sharp and the materialshould be warm.

**When using a material that youare unfamiliar with you should tryto consult the manufacture cata-log to see the working time of thematerial before using it. Theworking time for materials rangesform 1-7 minutes. In generalhighly, perforated and thinnermaterials have a shorter workingtime while thick solid materialshave a longer working time.

**Watch out when using narrowstraps that you do not cause thepatient compression issues.Wide, soft or neoprene straps willhelp to decrease compressionand shear forces on the skinfrom narrow straps. However,the soft straps do not have aslong as a life as the traditionalhook and loop straps which mayincrease overall splint cost. Oneway to prolong the use offoam/soft straps is to reverse thestrap once the original sidewears out.

**If you use narrow straps youcan pad the strap for comfort anddecrease potential compressionsites.

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at end range until the patient re-adjusts the splint to optimize thecombination of ROM and tension.The value of empowering the patientto adjust the splint cannot be over-stated. My patients have readilylearned and applied SPS adjust-ments. One patient, referred fromanother therapist with an elastic ten-sion splint, had the opportunity tocompare the two types when I con-verted his splint to SP. He emphati-cally preferred the SP splint andexplained how much he enjoyed theability to adjust the tension himself,both for comfort and to acceleratehis PROM gains.

In contrast, elastic traction deprivesboth the clinician and the patient ofcontrol over force because springsand elastics deform over time.Even when the clinician thinks that

he or she has set the splint tension,patients will change the type or thelength of the rubber band or willdeform the spring in an often futileattempt to control splint tension.Ultimately, the patient exerts the finalcontrol over a splint that exerts toomuch or too little tension wheneventually, the patient removes thesplint. In addition, with an elastictraction splint, the patient can pullagainst the force and shorten the tis-sue on an intermittent basis. Thisthwarts the entire splint purpose,that of holding the tissue at its maxi-mum length for long periods of time.

MAXIMIZE SPLINT TOLERANCE,COMPLIANCE, & “DOSE” OF END

RANGE TIMESince the SP splint positions thejoint precisely at end range with the

appropriate amount of force andbecause the patient has the ability toincrease and decrease tension, itmaximizes splint tolerance. Thisfosters compliance in the form ofconsistent and multiple hour splintwear. The total end-range-time(TERT) directly affects the speedand amount of PROM gained. Thus,the dose of splinting that the patientreceives is critical to achieving opti-mal outcome.

POTENTIAL FOR NIGHT TIMEWEAR

With good splint tolerance comesthe possibility of splint wear duringsleep. Wearing the splint duringsleep reduces or eliminates theneed for daytime splint wear whenthe splint would interfere with func-tional use of the hand and exercise.The patient

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CONTINUED ON PAGE 11

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1)Static progressive

2) False

3) Static progressive splints

4) Advantages*Patient-controlled force*Enhanced splint tolerance*Excellent compliance*Maximum "dose" of end rangetime*Potential for night time wear*Works with soft- or hard-end feeljoints*Removability for hygiene, functionand exercise*Cost-effectiveness

5) True

6) SPS Facts*While combining elastic compo-nents with inelastic componentsdoes increase the control overforce generated, it is not the sameas SPS.*SPS effectively treats both softend-feel joints and hard end-feeljoints*SPS is cost effective and notexpensive*SPS generates a wide range offorce from extremely low toextremely high*SP components can be used withany mobilizing splint design inplace of any elastic component

7) True

8) True

9) Implications*Substitution for loss of motorfunction* Correction of joint deformity*Provision of controlled motion*Fracture Alignment *Wound healing

10) 5 to 10 degrees per week

11) Precautions* Patient’s cognitive status*Normal functional anatomy andbiomechanics* Force should be tolerable to thepatient*Pressure areas*Monitor and adjust frequently*Listen to patient; splint must fitwell*Decreased sensation or alteredbiomechanics

Concern: Using a wrist rest while typ-ing at a computer.

Comment: Wrist rests are designed tohelp with positioning the wrist and tolimit extreme or awkward positions.The problem with the wrist rest, or anyobject, is the constant or static pressurefrom resting the wrists on the device.The median nerve is vulnerable on thevolar forearm from static pressure.When a worker does not take breaks orkeeps the wrist on the device compres-sion of nerve can occur. One solution isto use the soft flex glove. (see photo)It is a great soft splint that takes thedirect pressure off the median nervewhile using wrist rests.

Problem: Unaware of high risk behav-iors.Solution: Become aware of high risk

activities and modify or eliminate.

High Risk Postures and/or Activitiesto Avoid

**Sitting or standing in one position forlong periods of time. Change your posi-tion often to relieve muscle strain. **Using your wrists in flexion, extension,or a twisted position for long periods oftime. Maintain a neutral (straight) wristposition when using tools, typing, writingor reading. **Leaning on your elbows and wrists. **Holding your head down and forward. **Elevating your shoulders. **Hitting the keyboard and other objectsharder than necessary. **Gripping tools, books, and utensils tootightly (adapted from working well ergonomics)

Problem: Not sure how to position thecomputer equipment.

Solution:There are options for the height of thesurface that supports the keyboard andmouse depending on what type of key-board you use and your typing style. Inall cases, the keyboard and mouseshould never be higher than yourelbows. To find your elbow sitting heightyou need have feet firmly on floor withknees just slightly lower than hips. Yourhands should be even with your elbowsor slightly lower. To determine the cor-rect keyboard and mouse surface heightfor yourself consider the following:

** Place keyboard 1" lower than handsfor an ordinary keyboard.

**Place keyboard equal to elbow heightif you look at your hands to type.

** Your work surface (desk) should beabout 2 inches above your workingelbow height

(adapted from working well ergomonics)

(Answers from page 6)

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receives approximately 8 hours oftherapy during a period when little isusually accomplished therapeutical-ly.

WORKS WITH SOFT OR HARDEND FEEL JOINTS

A common misconception is that cli-nicians should use SPS exclusivelywith hard end-feel joints and elastictension splints exclusively with softend-feel joints. While many clini-cians have found that SP splintsdemonstrate a high level of effec-tiveness with hard end-feel joints,they also find that SPS improvesPROM of soft end-feel joints fasterthan elastic tension splints. Clinicalexperience has shown that elastictraction splints often fail to improvethe PROM of "hard end feel" joints.This may be due to the splint toler-ance factors described above andthe inability for the patient with ahard end-feel joint to wear the splintlong enough to experience adequateTERT to achieve tissue remodeling.

REMOVABILITYIn contrast to serial static splintssuch as serial casts, the patient canremove a SP splint for periods ofexercise. AROM encourages func-tional organization of scar tissue andfacilitates lengthening of adhesionsin both directions. Motion promotesnourishment of cartilage and helpspump high protein edema into thelymphatics. Bash and Spur state,"Serial casting immobilizes the arm,interferes with the performance ofhome exercise and activities of dailyliving, and may cause stiffness in theopposite direction."

COST EFFECTIVENESSSPS helps the therapist achievesuccessful outcomes as quickly aspossible and with the least possiblecost. The speed with which SPSsucceeds results in a reduction in

the number of treatment sessions.Bonutti et al demonstrated that SPSimproved PROM in cases where noother conservative treatmentapproach was successful. Suchproven efficacy demands that clini-cians seriously consider this treat-ment approach. SPS accommodatesincreases in joint mobility without theneed to remold the splint, saving thetime for re-molding or re-fabricationto progress PROM that serial-staticsplints require. Many SP compo-nents are reusable, minimizingmaterial expense.

Physicians and therapists havedescribed patients with contractureswho were scheduled for surgicalrelease prior to application of SPS.Because of SPS's success, surgerywas cancelled. When comparingthe cost of SPS to surgical releaseof a joint, its effectiveness and fiscalefficiency becomes apparent. SPShas offered PROM improvementsimilar or better to that gained insurgery without the risks.

SPLINT REGIMENSPS generally follows the same reg-imen guidelines as any other splinttype. Each clinician determines theappropriate splint regimen for apatient. After a brief trial period todetermine tolerance, the clinicianinstructs the patient to wear thesplint for longer periods of time. Theclinician should keep this basic prin-ciple in mind; the more time thepatient spends at end range, thefaster the PROM limitation willimprove. Adapt this principle foreach patient.

In my clinical experience, the patientwith a soft, springy end-feel contrac-ture can wear the splint for 3-4hours per day and obtain rapid,excellent results. At the otherextreme, patients with well-estab-lished, hard end-feel contractures,

may need to wear the splint asmuch as 23 1/2 hours a day, remov-ing it only for hygiene to achievePROM goals. Gains of 5°-10° at ajoint per week indicate splint suc-cess. The splint wear schedule mayrequire some experimentation beforethe clinician and patient discover theoptimal one.

After clearly explaining scar's abilityto remodel, the clinician instructspatients to position each joint so thatthey experience a mild to moderatestretch sensation at the joint or inthe tissue adjacent to the joint.Patients must understand that gentlestress will give them the results thatthey seek. While wearing a splintmay not be easy, it must be painfree. Clinicians will find it extremelyhelpful to instruct their patients thatthey will always experience stretchbefore pain. This will assist withproper tension adjustment. Patientsmust also understand that using toomuch tension will not increasePROM faster. Rather, high forcewill further injure the tissue, produc-ing more scar and increasing thetime until the joint moves as theywould like. Seldom does a patientignore these warnings when the cli-nician states the precautions clearlyand emphatically.

SPLINT DESIGNIt is a common misconception thatstatic-progressive splinting can onlybe used with certain splint designs.You can use SP force generatorswith any mobilizing splint design.Simply replace the elastic compo-nent with a static-progressive one.(See figure 4 page 12)

FORCETo provide the optimum amount oftorque force, each joint splinted willrequire its own individual SP compo-nent. Therapists have always usedseparate elastic com- continued on page 12

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ponents for each joint in mobilizingsplints and with good reason.Assessment of two adjacent stiffjoints will almost always reveal thatthe amount of torque required toposition each joint at end range dif-fers and that PROM of each pro-gresses at a different rate. With sep-arate SP components, each joint willreceive the correct amount of torqueforce and can progress according toits own unique rate. An exception tothis "one-joint, one-component" ruleis when the tissue restricting motionis not specific to the joint structurebut rather the extrinsic soft tissueaffecting a joint series, for examplethe MPJ and IPJ of the thumb, suchas with extrinsic extensor tightness.Another exception, example iswhere the unique splint design, suchas the UE TECH Final FlexionSplint--distributes the torque of oneSP component to position each joint at maximum tolerable end range.

COMBINING SPLINT APPROACHES

Clinicians sometimes confront thechallenge of a joint with limitedPROM paired with the need for peri-articular structures to undergoAROM. When AROM is essentialand PROM is limited, the clinicianshould consider combining staticand elastic traction approaches.

Clinicians may find that their patientscan wear the splint in elastic tractionmode during the day and in static-

progressive mode at night duringsleep. The clinician may also instructthe patient to alternate betweenelastic and static-progressive trac-tion during the day.

Splints may also combine serial-stat-ic and static-progressive or staticand static-progressive splints.Thesplint in figure 5A (pg. 14) illustratesthe use of serial casts for PIPJextension with static-progressiveMPJ extension in one splint for apatient with extrinsic flexor tightness.An alternative design for the sameproblem, is shown in figure 5B (pg.14). This splint puts a static fingerextension platform together withstatic-progressive MP extension.The splint in figure 5C (pg. 14) effec-tively combined a static interpha-langeal (IP) joint extension splintwith static progressive flexion postmetacarpal fracture when the patientlacked MCP flexion and IP jointextension.

From www.AOTA.org**A 2-year moratorium on outpatienttherapy caps, included in the legisla-tion, will provide protection for benefici-aries through 2005, and restore $700million to outpatient rehabilitation.President Kornblau met with SenateMajority Leader Bill Frist of Tennessee,thanking him for his support of the 2-year cap moratorium.

**New Hand Special Interest SectionProposed(January 16)--Efforts are underway tocollect the 1,200 signatures needed toform a new Hand RehabilitationSpecial Interest Section open to allAOTA members regardless of specialtypractice

**AOTA’s Approved Provider Program(APP) is designed to promote the qual-ity and relevance of continuing educa-tion (CE) activities offered to occupa-tional therapy practitioners. Exploringhand therapy, Inc. is an ApprovedProvider.

From: www.ASHT.ORG**Relating to Custom made orthotics:CMS announces the Standard UniqueHealth Identifier for Health CareProviders for Use in StandardTransactions under HIPAA.Filing and processing health careclaims and other transactions will beused through one standard healthidentifier called the National ProviderIdentifier (NPI). This was announcedas of late January and establishingstandards is still underway. The dateof this rule to be finalized is May 23,2005. The need for NPI resulted froma mandate because of new HIPAAguidelines. For more information,http://www.cms.hhs.gov/media/press/release.asp?Counter=946**CMS accepts comments onProposed Regulations via Internet.CMS is introducing a new tool for citi-zens to make their voices heard.Everybody can visit: www.regula-tions.gov to submit any comments orconcerns in regards to pending legisla-tion.

From: www.HTCC.org**The HTCC Board of Directors adopt-ed this revised definition and scope ofpractice in May 2002

Hand therapy is the art and science ofrehabilitation of the upper quarter ofthe human body. Hand therapy is amerging of occupational therapy andphysical therapy theory and practicethat combines comprehensive knowl-edge of the upper quarter, body func-tion and activity. Using specializedskills in assessment and treatment,hand therapist promote the goals ofprevention of dysfunction, restorationof function, and/or reversal of the pro-gression of pathology in order toenhance participation in life situationsfor individuals with upper quarter dis-ease or injury.

** Visit the HTCC website to learnmore about hand therapy and theissues that effect practicing hand ther-apists.

Figures 4A & B depictshow you can use SP forcegenerators with any mobi-lizing splint design.Simply replace the elasticcomponent with a static-progressive one.

Figure 4A

Figure 4B

Continued on page 14

Cord with MERiT device

Elastic

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14

The clinician can use multiple typesof SP traction in one splint. The splint in fig. 6,shows a MERiT™component trac-tioning the wristinto ulnar deviationwhile hook andloop tape exertspull on compositethumb MCP/IPflexion for apatient post deQuervain's release.

Using creativity and expertise, theclinician has many options andsplinting combinations available to treat a patient's PROM problems. The clinician can apply the static-progressive approach to any joint inthe upper extremity. (Fig 7)

SUMMARY

Clinical experience and researchhas supported the efficacy of static-progressive splinting to improvePROM quickly and efficiently. Withso many advantages, it is difficultnot to consider static-progressivesplinting as the technique of choicewhen faced with PROM limitations.The combined benefits of achievingprecise torque and joint position withpatient-controlled tension result inhigh splint tolerance, complianceand patient satisfaction. The static-progressive approach creates ahighly effective means to deliver anadequate dose of total-end-range-time. Maximizing TERT will providethe achievement of treatment goals.

Clinicians report cases of improvingPROM when no other approachworked. Due to their success withstatic-progressive splinting, clinicianshave reported the cancellation ofscheduled patient joint capsulo-

tomies. SP splint components giveclinicians the needed tools toachieve patients' goals whether it isavoiding surgery or increasingPROM in an efficient and cost-effec-tive way. Nothing can give the clini-cian greater satisfaction.

KAREN SCHULTZ-JOHNSON MS OTR FAOTA CHT received herMaster's of Science degree inOccupational Therapy fromCalifornia State University at SanJose 1982.She has spe-cialized inhand rehabili-tation since1978. Shehas been anactive memberof theAmericanSociety of Hand Therapists since1983 and a member of the ASHTboard from 1985-1992. Karen par-ticipated on the editorial board of theJournal of Hand Therapy for 3 yearsfrom 1987 - 1990.

Karen became a certified hand ther-apist in 1991 and is certified in painmanagement. Karen is the ownerand director of Rocky MountainHand Rehabilitation in Edwards(Vail), Colorado. She owns UETECH and has designed splints andexercise equipment that are distrib-uted internationally. She is anadjunct faculty member at RockyMountain University of HealthProfessions in the Doctor of Scienceprogram in Hand Rehabilitation.

Karen has worked as a consultant tosports medicine clinics to set uphand therapy services. She hasprovided ergonomic consultation tooffices and industries. She hashelped therapy vendors develop andmarket productsand product lines.

SPS FACTS**While combining elastic compo-nents with inelastic componentsdoes increase the control over forcegenerated, it is not the same asSPS.**SPS effectively treats both softend-feel joints and hard end-feeljoints**SPS is cost effective and notexpensive**SPS generates a wide range offorce from extremely low toextremely high**SP components can be used withany mobilizing splint design in placeof any elastic component

Figure 7 When AROM isessential and PROM is limit-ed, the clinician should con-sider combining static andelastic traction approachesin one splintFigure 5 AThe splint in Figure 5A illustrates the use

of serial casts for PIP extension with static-progres-sive MP extension in one splint for a patient withextrinsic flexor tightness.

Figure 5B An alternative design for the same prob-lem, the splint in Figure 5B puts a static fingerextension platform together with static-progressiveMP extension.

fig 5C

fig 5B

Figure 6. The clinician can use multiple types of S-Ptraction in one splint. This splint shows a MERiT™component tractioning the wrist into ulnar deviationwhile hook and loop tape exerts pull on compositethumb MCP/IP flexion for a patient post de Quervain'srelease.

figure 6

figure 5A

Figure 5C Effectivelycombined a static inter-phalangeal (IP) jointextension splint with stat-ic progressive flexionpost metacarpal fracturewhen the patient lackedMCP flexion and IP jointextension.

Figure 7

Continued on page 15

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A published author, Karen's worksinclude articles in Journal of HandTherapy, and the Journal of HandSurgery, among others. She is theauthor of The Schultz UpperExtremity Pain Assessment,Volumetrics--a Literature Reviewand Static-Progressive Splinting.She contributed two chapters-"Work Hardening and workConditioning" and "Upper ExtremityFunctional Capacity Evaluation" tothe respected text, Rehabilitation ofthe Hand Vols 4 & 5. She servedas editorial consultant forIntroduction to Splinting: a Clinical-Reasoning and Problem-SolvingApproach 2nd Ed.Karen has spoken internationallyon many topics related to handrehabilitation including upperextremity anatomy, evaluation,splinting, work related programsand cumulative trauma disorders.

Karen received recognition as aFellow of the AmericanOccupational Therapy Associationfor her special contributions toOccupational Therapy. She waselected to "Who's Who of AmericanBusiness Leaders" in 1994 and to"Who's Who of Professional andBusiness Women" in 1999 for sig-nificant career achievements andcontributions to society

For additional information about theMERiT™ device please visit

www.uetech.com or call 800-736-1894

Don’t forget to mention ExploringHand Therapy (EHT) newsletter to

receive free monograph static-progressive splintingby Karen Schultz-Johnson

with any MERIT product purchase

Thank you Karen for your

invaluable input. You arean inspiration to us and the

hand therapy community.

CONGRATULATIONS to all the therapists that passed the HTCC exam in November 2003

Great Job!!!

Dear Susan and Nancy, It is with great pleasure and appreciation

I write to let you know how instrumental your products

were to me. I can recommend with complete confidence

your book and on-line courses to anyone whodesires

to gain a deeper knowledge of hand rehabilitation. Your products are priceless!!

They are a must for anyone wishing to successfullyprepare for the CHT exam.

As you know, I took the exam in November (first time) and am now a CHT!!

Marlisa Nolan OTR/L CHT

8318 40th Place North

St. Petersburg, FL 33709

www.exploringhandtherapy.com

727.341.1674

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ST. PETERSBURG, FL

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For more information please visit www.ClikStrips.com or contact:WFR Corporation, makers of Reveals™ Low Temperature Thermoplastics, at 201-891-1042

CCLLThe lowest profile,

most affordable,easiest way to make

Static-Progressive Splints!• lightweight• inconspicuous, streamlined design• easy to adjust low-load, prolonged traction• precise and concise repeatable increments• technique developed by a hand therapist -

Nelson Vazquez, OTR/L, CHT

Kit includes everything needed to make one MP Flexion Inelastic Mobilization Splint:1). Reveals™ Thermoplastic precut splint base 2). Pre-molded Cobra™ Outrigger3). ClikStrips™ Inelastic Mobilization Splinting Component4). Fabriplast finger sling5). Monofilament6). Line crimps

Part number WF-2003 $12.95 each kitSelf adjusts to maintain a 90 degree angle of pull!

A JAS Static Progressive Stretch (SPS) splint restores range of motion in joint contractures by delivering the benefits of the biomechanical principle of stress relaxation. Stress relaxation is the method a therapist uses to manually stretch a joint in the clinic. The unique design of the devices eliminates the risk of joint compression, as well as, offering soft tissue distraction. The treatment sessions are patient directed and the protocol calls for short 30 minute durations Visit this website for more info: http://www.theratechequip.com/jas.htm

Static Progressive Stretch to Reestablish Elbow Range of Motion

Peter M Bonutti, M.D.,* Jeffrey E. Windau, B.S.,** Brent A. Ables, M.S.,† and Bryan G. Miller, Ph.D.‡

Static progressive stretch (SPS) is a technique using the biomechanical principle of stress relaxation to restore range of motion (ROM) in joint contractures. Existing techniques such as dynamic splinting and traction rely on a time-dependent material property, creep, which applies to continuous load. Other techniques, such as serial casting and static splinting , are time intensive and usually require assistance by a therapist. This study evaluates SPS via a new orthosis that directly applies SPS incrementally through patient controlled therapy, allowing for stress relaxation of contracted tissue. Patients used the device in 30-minute treatment protocols. The length of treatment time varied between one and three months. Twenty patients with elbow contractures who had limited success with other treatment modalities including serial casting, dynamic splinting, physical therapy, and/or surgery, underwent SPS using the new orthosis. The increase in motion for the 20 patients in the study averaged 31° (69%). All patients expressed satisfaction, with no complications and no deterioration in ROM at the one-year follow-up evaluation.

This article is continued at: http://www.theratechequip.com/article2.htm

For additional research info go to: http://www.jointactivesystems.com/research.html#Burn%20Joint

5

Static Progressive Splinting:Up Close and Personal

On-site course: March 6, 2004-- Don’t worry if you miss it. View on: CD, DVD, or Internet Available March 20, 2004

Sponsored By:

Course DescriptionThis course is excellent for occupa-tional and physical therapists,COTAs, and PTAs evaluating, treat-ing, and making splint recommenda-tions for the hand and arm.

*Instructional methods include:PowerPoint, lecture, and demonstra-tion.

* The splints are fabricated slowlywhile you view fabrication on a hugescreen. Video/DVD productioncomes with course to allow you toliterally take the course home withyou! This is an intermediate levelcourse.

Upon completion of this courseyou will: *Familiarize yourself with anatomyand how it applies to splinting. *Become familiar with splint materialproperties for successful splintdesigns. *Learn how to fabricate a variety ofstatic progressive splints. *Learn a variety of marketplace stat-ic progressive splints available. *Learn tips, tricks and techniques tomake splinting simple.

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