The Hand and Upper Limb Splinting Service

These clinics aim to provide a specialised service, in which the Occupational Therapist chooses, creates and monitors (as appropriate) an upper limb splint. The aim is to increase or maintain a child/young person's functional skills. Splints may also be prescribed to reduce deformity or assist in the child/young person's activities of daily living.

Schedule and Venue

Splinting clinics are held on a regular basis at the City of Coventry Health Centre, Sherbourne Fields School, Tiverton School and Castlewood School. The Splinting Service currently offers appointments two days per week although the therapist can be contacted at other times if urgent needs arise.

Objectives

  1. To provide either a static thermoplastic splint or pre-fabricated neoprene semi-dynamic splint to prevent development of future deformities by correct positioning and decreasing the risk of contractures.
  2. To enhance functional ability of a child’s upper limbs by correct positioning.
  3. To support, educate, advise and monitor families, carers and educational staff using the splint.
  4. To offer the family a referral to other professionals when further hand investigations may be required.

Referral Procedures

Children aged 0-19 can be referred to the Coventry Children’s Hand /Upper Limb Splinting Service by parents/ carers and other health professionals. A referral form requires completing to ensure the Occupational Therapist has sufficient information to prioritise the child/young person.

Appointments

Upon receipt of a referral, the child/young person and their family will be offered an appointment to the next available clinic. A standard appointment letter will be sent. Due to the difficulties in co-ordinating clinic times, the Occupational Therapists and venues,there is limited flexibility in appointments available to families.

Indications For Splinting

  • Mild to moderate limitation in upper limb function

- Associated reactions influencing bilateral hand use (use of both hands together)
- Instability of joints
- Post surgery
- Post Botox

  • Moderate to severe limitation in upper limb function

- Associated reactions influencing bilateral hand use (use of both hands together)
- Instability of joints
- Post surgery
- Post Botox
- Contracture management

  • Severe limitation in upper limb function

- Contracture management
- Skin integrity
- Reduction of pain
- Post surgery
- Post Botox

  • Brachial plexus disorders e.g. Erb's palsy
  • Peripheral nerve injuries
  • Post surgery
  • Post Botox
  • Other medical conditions impacting on upper limb function or where the child is at risk of deformity

Assessment

At the initial appointment, the Occupational Therapist will assess the following:

  1. Reported functional impairment (child/young person and family)
  2. Functional observation of skills through play
  3. Tone
  4. Active and passive range of motion
  5. Hand functional assessments as appropriate
  6. Sensation
  7. Standardised assessments if appropriate

Reviews

All children issued with thermoplastic splints will be reviewed on a regular basis, in accordance with the following guidelines;

  1. Children under 3 years at least every 3 months
  2. Children over 3 years at least every 6 months

Children provided with neoprene splints will be given advice regarding the splint and discharged from the service; if the child outgrows the splint, or the splint becomes worn, a new referral will be required to the service.

Splinting is a specialist service which requires commitment and motivation from children/young people and their families. Therefore, compliance is very important! Children may be given rewards by the Occupational Therapist such as stickers and colouring sheets to make their splinting journey more enjoyable!