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Straightening Bent Fingers, No Surgery Necessary

Brynna Kaplan, an OT Doctorate student, created finger splints in the OT lab as part of a case study in Debby Schwartz's Preparatory Methods II course.

By David DeFusco Jane, a 20-year-old flag football player, jammed her left pinkie finger during a game with her college club team. The injury bent her finger at the middle joint, where it got stuck in that position because of swelling due to ligament damage. In order to facilitate Jane’s healing, Brynna Kaplan, a student in the Katz School Occupational Therapy Doctorate, created a special finger splint. Full disclosure: Jane isn’t real. Kaplan made her up for a case study as part of her four-credit course, Preparatory Methods II, which is designed to teach budding occupational therapists techniques they can utilize for injuries to the upper extremities. Kaplan created the scenario, determined a course of treatment, researched its application, and then presented a poster in class, much like what scientific researchers are invited to do at conferences. “It’s a tough assignment. Everyone did a fantastic job on making their orthosis, but Brynna did outstanding work,” said Debby Schwartz, an adjunct professor who teaches the course and is an occupational therapist and a certified hand therapist. Schwartz is known internationally for having written the definitive text, Orthotic Design and Fabrication for the Upper Extremity. In Kaplan’s scenario, Jane wasn’t treated by a specialist at first. Instead, she immobilized her finger for several weeks with a brace that she bought at a store. When the pain wouldn’t go away, Jane abandoned the brace and tried avoiding the use of her finger. As a result of the injury, she had difficulty grasping objects, completing self-care tasks and putting on gloves, thus greatly affecting occupational performance. Then the muscles in Jane’s finger began to contract, the injury’s most serious complication.

Kaplan's splint used Orficast, a thermoplastic material that conformed to the shape of her finger after it had been heated in 160-degree water.

“Before fabricating an orthosis for clients, it’s imperative for practitioners to first gain an understanding of their client’s meaningful occupations,” said Kaplan, “their daily routines, their condition, the stage of healing they’re in, the goals of using an orthosis, and all other factors relevant to the treatment process.” In the Katz School’s OT lab, Kaplan heated a two-inch by two-inch strip of Orficast in 160-degree water for two to three minutes. She then molded the thermoplastic material around a classmate’s finger until it hardened. Such materials are frequently used in the fabrication of custom orthoses, or splints, for people with injuries to the hand and upper extremity. The splint also featured two coils that can be adjusted to achieve an optimal level of tension. Sustained tension lengthens the soft tissue over time and mitigates against contraction of the muscles. “I was extremely proud of my result, and I am astonished at how much I have learned over the semester,” said Kaplan. “I got immense gratification fabricating these orthoses.”

The splint is supported by store-bought hinges that can be adjusted to provide the optimal level of tension for preventing muscle contraction.

In the case study, Jane wore the splint for six to 12 hours a day for eight weeks while attending occupational therapy sessions to stretch the muscles around the injured joint and to test for range of motion, dexterity and sensation. Kaplan said practitioners should consider the orthotic design, material used, fit, customization and the prescribed wearing schedule to achieve the goals established by the occupational therapist in consultation with the client that will lead to a successful outcome. Hand therapy is a specialty certification that Katz School students in the Occupational Therapy Doctorate can pursue after graduation. It requires several years of practice, a strong background in anatomy, including knowledge of the limb’s bony structures, muscles, tendons, ligaments and nerves. Hand therapists need to know what clinical conditions affect the upper extremity, like arthritis, and they need to know how the body heals, as well as limb positioning and exercises that enable healing. Practitioners must then pass a comprehensive examination to become certified. “This case study showed that when we gave Katz School students the freedom, they channeled their passion for helping others in need by becoming creative problem-solvers,” said Schwartz. “My ultimate goal is to open their eyes to the possibility of specializing in hand therapy after they graduate.”