Considerations and Tips for Orthosis and Splints (Workshop August 5)
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[00:00:00] Hey guys, it's Hoang here. It's been a hot minute since I've been on live. I am tuning in live on Instagram. I'm on Facebook, I'm on YouTube. So I hope that you'll. Join me with, you're watching this live or you're gonna watch this on replay. Play along send me questions, ask questions, tell me a little bit about where you are and whatever you wanna share, like where you are from a location standpoint, where you are in your journey.
[00:00:30] My name is Hoang. I'm an occupational therapist and certified hand therapist. I'm located in the lovely Miami, Florida. It is hot outside, but. Thank goodness my air conditioning is working. I'm coming into live from my clinic, Hands On Therapy Services. Let me see if I can show you. That's it's the back office of my clinic.
[00:00:48] Let me see if I can share a little bit of that. I can't really move the camera that much, but I wanted to come on live today 'cause it's been a while and. I've had a [00:01:00] few cases come in I want to share about, as it pertains to prescribing orthosis. I'm also, it comes at such a great time because I.
[00:01:11] In the mentorship program, that's a program that where I, we focus on developing our skills where we focus on providing, developing your skills to provide, really awesome, amazing treatments for your patients and helping them progress and getting them to hit their goals.
[00:01:29] Hey, there's CHT in the upper peninsula of Michigan. Yay. Awesome. Thanks for tuning in. Yeah, definitely let me know where you're tuning in from. As I'm talking, feel free to type in your questions and I know that sometimes you don't have questions while I'm speaking, so feel free to just send me a message afterwards.
[00:01:47] And one thing that I've noticed, I'm going off a little topic a little bit, sometimes people have a hard time with questions, and so just tell me your thoughts. Some of your thoughts, that's totally fine as well. But I wanted to bring up orthosis [00:02:00] 'cause it's just it's, it keeps coming up both in my clinic but also in as I teach in the program.
[00:02:06] So inside the mentorship program, we just wrapped up last month. We just wrapped up last month hands, right? Different types of hand injuries. And then this month of of August, we're gonna go into risks. And in both those kind of scenarios and instances, we're always talking about we're talking about what kind of splints people need and which one should I.
[00:02:28] Which one should I be making? And I don't know about you, but I certainly get a lot of people who come in with prefab splints already. So I wanted to share some of, some of the considerations, some of the things I'm seeing, so hopefully that it can help you two in your practice. Because more and more people are just literally going on Amazon and ordering shit, and they don't even know.
[00:02:49] What the fuck they're doing. But it's our job to help them our, it's our job as therapists to, give them some guidance in terms of, what really works and what doesn't. To me, I'm like, if you [00:03:00] wanna order them, who am I to stop you? Go ahead and order them.
[00:03:03] But I can really, honestly help them if I can give them some guidance in terms of what really works and what doesn't. And I think that too often, and I'm guilty of this, like definitely guilty of it, like very early on. In my career, which just like it was all about making custom fitted orthosis, it was all about the practice of actually just making stuff, playing with the material.
[00:03:26] And so there's that component, like we have to get really good at making them. And that is one component. I don't wanna minimize how important that is, but I think that besides just learning how to make them, we need to ask. Experts, we need to know how to prescribe them and prescribe meaning. When people come to you, they have questions.
[00:03:51] Your patients have questions, sometimes they just don't know how to ask, right? So it's our job to really be able to discuss [00:04:00] those things that they need before. Before they ask. That's one part of anticipating someone's needs, right? I just wanted to share some of the things that I've seen and you can tell me if this is something you're seeing in your clinic.
[00:04:13] 'cause I think if I'm seeing it, y'all, people seeing it too, but yeah. So when it comes to, when it comes to. Custom fitted orthosis or splints, let's just say splints in general. You have custom fitted and you have prefabs, right? They both play a huge role in the hand therapy rehab, and one is not better than the other.
[00:04:32] It's just which one is required at the time. Injuries progress and they change, and so you have to know when to prescribe which one. Based on the needs of your patients. What do you prescribe to them? What do you either one, make or two prescribe? And that's really key. Can we briefly talk about split materials that you use in your my clinic, Jen? I'm going to I'm gonna explain a ton of that more. [00:05:00] During the orthosis workshop, so I'm gonna do an orthosis workshop. I'm gonna do an orthosis workshop August 5th at 12:00 PM Eastern time. That's for just my members. So if you're in the mentorship program, if you're in the exam prep program, if you have in the.
[00:05:18] Past purchased Orthosis 1 0 1. You're gonna get free access to this orthosis orthosis workshop. And I'm gonna dive into split materials and whatever other questions, patterns, what to make. So definitely I will answer those. And it's funny 'cause they've changed over the years. My, my favorites it's changed a little bit over the years.
[00:05:40] But yeah, like when it comes to making. Making splints materials very important, Jen, right? You gotta find the ones that, that you like, that you're comfortable working with. And as you get better, they might change a little bit but you gotta know which one you're making, right?
[00:05:57] Is that shit long? Is it short? Does it [00:06:00] include this joint? Does it include that joint? Those are the most important decisions that you, as the expert in your area need to be making. I was, I wanted to share, 'cause I think this is gonna happen more and more to us as occupational therapists because, it's just economy, right?
[00:06:18] It's just like changes in healthcare and you either can change with what's going on and adapt and improve or you can die. A slow death of, saying that I don't want these changes 'cause they're gonna happen regardless of whether you want 'em or not. Prefab splints are, Easily readily available to people.
[00:06:38] Majority of patients are going to buy them, try them before they even talk to you as a occupational therapist before they even talk to you as a hand therapist. We need to understand how that plays a role and how we fit in, and how we can still greatly contribute. To people's lives. So [00:07:00] I had and I like you guys have stories too.
[00:07:03] I'm just gonna share with you mine, just because it just happened I think earlier this week. This patient came to me after I like drawing on my hands after a ulnar collateral ligament tear of the thumb. So this is radial we have for every joint. So for every joint we have ligaments that hold them and they all do different jobs for the most part when you get into the nuances.
[00:07:30] But ligaments hold bone and bone together and they give you stability, period, right? I don't care what part of the joint or which joint it is. Ligaments hold bone and bone together and give you stability. So when you tear one of them, when you tear one of them then. You might need therapy, but obviously there's a range of how you tear it.
[00:07:49] You have sprain and strains, which is just like you're twisting, you're, you are tweaking, you've got micro tears, very small. Then you have partial tears, or how bad are those partial tears? And then you have [00:08:00] full thickness tears, right? So my guy came in with a full thickness tear. Right ulnar collateral ligament.
[00:08:07] Not only did it tear that ligament folded up, up in itself because of how bad he tore it, he fell on his thumb and pushed it like this, right? So if you can imagine the ligament holds you and In place. So if you push it too far, it's gonna tear. His tear was so bad that it tucked itself in, and that's called the Steiners lesion.
[00:08:32] So without going into detail, he had surgery. And I don't think he waited. Obviously they didn't try a conservative treatment. He had the surgery, they pinned him. Which then what it does is it helps you to stiffen up, right? And they. They pinned him. I think he was in a post post-op cast. And then once they removed the pin he got himself a a [00:09:00] prefab splint that he ordered online.
[00:09:01] I don't know what the doctor said. I. I don't know. This is what I'm getting. So this is what you're getting right? And truth be told, this is how patients are coming to you. They're coming to you already with, not fresh out of the gate unless you work at a hand surgeon's office and majority of us don't work there.
[00:09:20] I myself, when a work in a private practice, I don't have affiliations with anybody. Like I work together with them. I collaborate with people, doctors know me. I've been in the, in the field, especially in Miami for over 20 years, I've gotten to know lots of hand surgeons. But I'm I'm not essentially I'm not in bed with anybody.
[00:09:37] He had the surgery and I'm sure the doctor said a lot of different things to him, but all he told me was they didn't even tell me what to do. Except for to go to therapy. And he came in with a splint. He was like, I just he literally, I'm going on vacation. I need to know what to do.
[00:09:53] Help me. And that's exactly what I did. I was like, okay, so based on this injury, [00:10:00] I see you came in with a splint. Can you show me how he had already taken off? 'cause he wanted me to see his hand and he wanted me to see his scar. And I was like let's go ahead and put your splint back on.
[00:10:09] Let me see what you're wearing. 'cause one of the things that I like to do is I like to see, and I like to look at fit right? Write that down. You need to look at fit. If someone's coming in to you with a pre-fab splint already, bring it in. Bring it in. I wanna see what you're using. Let me see And look at fit.
[00:10:27] And I wanna know, is it blocking something? Is it blocking something? It's supposed to block? Is it blocking something? It's not supposed to be blocking, because that's gonna interfere with your recovery process. So then I can educate on that and I can say, Hey, based on, your.
[00:10:42] Your surgery, this splint is, it looks good, right? So in his case, I was like, yeah it's decent, right? It's, if you're comfortable with it, it fits, it's fine. My only issue is it blocked you just a little bit, right? You're supposed to be able to move your low knuckles blocking you a little bit.
[00:10:59] [00:11:00] So at the beginning, that was great. But now I actually don't want you to use that splint, right? Because now it's gonna slow you down. You wanna recover in a relatively good time, right? You don't want complications of stiffness. You don't wanna prolong your therapy, do you? Of course not. So that splint is a little bit high.
[00:11:17] It goes a little bit low beyond your wrist. And it doesn't need to, so it's blocking you just a little bit. So you don't necessarily need that. And so one of the things, once you look at the fit, then you have to decide is it good fitting, is it bad fitting? And then educate based on the injury that you have.
[00:11:37] So in my case, I educated him and I was just like and I show it. You see how it's here? You wanna be able to move. So then I could prescribe to him what he can do with that splint. And my prescription was you're five weeks post-surgical. You're pretty stiff. I, you need to start weaning out of this splint.
[00:11:58] I don't have a problem with a prefab [00:12:00] splint. It just, the, your patients, and, even my patients, they don't know what to do. They don't know when to use it. They don't know how to use it. They don't know when to get rid of it. So it's your job. So first of all, you figure out what you need to make in his case.
[00:12:17] I didn't need to make anything. I was able to use his prefab and then say what was good and what wasn't? And that's number two is the why. What did you make and then why did you make what you needed to make? If that's a good fit, then why is it a good fit? And then what are you looking for?
[00:12:33] What are you looking for in terms of progress or problems? So if it's blocking you, it's gonna stop your progress, right? These are the particular problems that I can foresee and anticipate if you don't use the splint correctly. I've seen many people use splint incorrectly, or they're not They're not told on how to use it.
[00:12:53] And the thing is, patients need to hear things over and over. They can be told, but they've been told one time, it's just not always [00:13:00] enough. They need to be told multiple times. They need to be told how to progress, what to look for. So hopefully this guy will come back, when he comes back from vacation and maybe he needs a little bit help, but I already told him, yes, this point's okay, but here are some issues.
[00:13:14] And then the other thing is Number four is like you, you gotta know when to discharge something or change or modify, right? So these are all considerations when it comes to orthosis prescription. I. This has absolutely nothing to do with your hands on making it, materials and all that good stuff.
[00:13:34] Just on the prescription alone, there are considerations that you have to take into account because some of your patients are coming to you already with something. It could be from another clinic. They could come with nothing. They can come with a prefab. And so these are some of the considerations that, I think is really important to.
[00:13:53] To take into account when you are when you're prescribing an orthosis. It's just, it's not enough to say, Hey, you need [00:14:00] this. You need to say what you need. I think you need this one, right? I need this. A short thumb spike up and you have it. It's just a little bit long, but that's the correct one.
[00:14:09] While you need it while you had the surgery, it was really important to stabilize this joint right here. And it's gonna allow your ip, your little joint to move. It's gonna allow your wrist to move. It's gonna allow this joint to move, right? So this essentially, it's just like your finger, right?
[00:14:27] This is your big knuckle. This is your middle knuckle, and this is your little knuckle. It's very similar to your finger. This is your big knuckle. Your middle knuckle and your little knuckle, right? So what we're gonna do, we're gonna block this middle knuckle to give it support, but you can move all the other joints, right?
[00:14:45] And then at some point, like while you are still at five to six weeks, if you're doing anything heavy, he's traveling. So it's if you're carrying luggage, You don't wanna do anything where it's like a super heavy grip. 'cause when you do super heavy [00:15:00] grip, what happens? There's stress on the ligament that you repaired, so you don't wanna overstress that ligament.
[00:15:06] Also, pinching like this, puts a lot of stress on that ligament that you just had repaired. So you can use or you can move your finger, you can move your thumb, and you're trying to get as much motion as possible without pain. But when you're doing heavier stuff, that splint's gonna support you, otherwise don't wear it.
[00:15:26] So I prescribed for him to wear it when he's doing heavy stuff, like the lifting during the traveling. If you're in a crowded area, you don't want anyone to be grabbing your hands, right? Shaking your, was it his right hand? It was his right hand. You don't want people who don't know you just grabbing it, shaking you real hard.
[00:15:44] That shit's gonna hurt. So that's when you would wear it. And the other time you'd wear it, it's like when you're sleeping, right? Still fresh and new. When you're sleeping, who knows? You're gonna grab that comforter and pull it. You could re-injure yourself. I don't think he's, [00:16:00] 'cause he was really stiff, but for the most part, those, that's what I prescribed to him.
[00:16:05] And then by week six, you more off. And by week eight you want to get rid of it. So we're in the part where we're, discharging, changing or modifying. So those are some things that you can consider when you're working with any kind of hand injuries. And I wanted to share one more story in, in terms of in terms of considerations for orthosis.
[00:16:32] Fabrications, right? Prescribing orthosis are in stroke in patients with strokes, right? So most of the time say she's are known for Orthopedic types of cases. I broke something, I tore something, I cut something, or I got nerve compressions. Those very orthopedic types of issues. Even as a certified hand therapist, you need to know how to work with people with stroke injuries because stroke injured patients have a lot of [00:17:00] hand and upper extremity.
[00:17:01] Therapy needs. This is such a an important group of people that really need the help of hand specialists. And so if you're an occupational therapist and you don't wanna become a certified hand therapist, I still would encourage you to understand splinting principles. Okay. Splinting principles, and why you would pick which splints, because it's when you say, oh, I'm a neuro patient.
[00:17:30] Not a nervous, I'm a neuro therapist. I don't do, like I'm a neuro therapist, I don't do hands. Or you're a certified hand therapist and you're like, oh, I'm a C H T, so I don't do neuro. So what I wanna encourage you to do is think that might not be your area of expertise, but understanding splinting principles really allow you to understand how to prescribe how to educate, and also maybe who to refer to, right?
[00:17:57] Who to refer to get the needs if [00:18:00] you yourself don't have the skill. I have a patient that came in. Early, this week, who came in with he had a stroke, right? So he came in with limited motion, flexor synergy, joint contractures, and he came in with a burn. He had a post stroke burn.
[00:18:23] All affecting his hands and his arms, right? Strokes come in with a padded blue Amazon swing. Girl, don't we know it? He came in with the same thing. Most don't wear because it pulls on their thumb. I hate that splint. Girl, you and me, we the same. And here's where. The principles and the considerations make a huge difference in terms of your prescription of what splint to make right.
[00:18:49] And so that's why I'm here saying like OTs, we work with hands and upper extremity. I don't care what setting you work [00:19:00] in. I have been in a skilled nursing, I have been in acute care. I have done home health. And majority of my practice now is in upper extremity ortho, but I do get the strokes that come.
[00:19:18] I get the nerve cases, I get the brachial plexus cases. These are all nerves and young people studying for the C H G. This falls under your study, so you know. Chds have a bad rep because we'd be snooty as shit about, just saying ortho cases. But let me tell you, if you really wanna serve the people who come to you, understand strokes, right?
[00:19:41] You might not be the one, treating it all day, every session or whatever, but you really gotta understand the consideration and the principles because this is why patients come in. And there's been a lack of attention to their hand and arm. To their hand and arm. So this guy came in already and [00:20:00] everyone presents differently.
[00:20:01] And I'm not throwing any shade to any therapists because I. There's a lot going on when you have someone with a stroke, right? There's just a lot going on and every person presents differently. My guy came in with joint contractures of the p i p majority of the time. I would say that they're not contracted because when you, so for example, If you have a patient who had a stroke and you put them inflection, okay, this is synergistic risk.
[00:20:31] Motion, right? So when there are risks, if you just follow along, play at home. You are watching the song replay. Do it with me. If you just naturally relax your hand and you put your wrist into flexion your fingers naturally extend. If you take a look at them, your index finger is very extended, right?
[00:20:52] And then all your other fingers are extended, but they have a cascade of range of motion and then your IPS all fall [00:21:00] into slight p i p flexion. Just slight probably 20 degrees, right? If you passively right passively, put your wrist into extension, your fingers go into flex go into flexion, that is synergistic wrist motion.
[00:21:18] A k a tenodesis, right? So what happens is they take that natural. Cadence, right? They take that natural cadence of positioning in their hand when the wrist most people with strokes have a flexor flexor synergy, meaning they're, they curl in. So their biceps are real strong curling with a tone their flexors.
[00:21:46] Curl in this. And so as they move and walk and move their trunk and try to use their shoulders, their tone kind of kicks in. So they fall into this. And so the detriment of what happens is that they can develop joint contractures, right? [00:22:00] So then we try to move them into risk neutral. Or risk extension.
[00:22:04] And majority of the time we're trying to extend them, right? So we want, we were like, oh, we just wanted to stretch you and extend you. So you're flexors, but you're fighting against tone, right? So my guy came in, he had. Already developing a risk, a slight risk contracture, but his mps were already very contracted and his ipss were very contracted.
[00:22:25] So when you have somebody who has contractures or they have really high tone, Prefab splints, like the ones you find on Amazon I've been guilty, ordered them myself early in my career. They come from skilled nursing facilities. They come from acute care. Been there, done that. And what happens is, and remember how you are at the beginning of your quote unquote injury, right?
[00:22:50] There's an injury to the brain, how you are. At week one is different from what you are two months, three months, five months, six months away. So [00:23:00] that's why I'm trying to say I'm not here bashing therapists, blaming people for saying, oh, you put the wrong splint. You didn't, you might not have put the wrong splint.
[00:23:08] They hand and arm changes. So with patients with strokes, their arm and hand and their recovery process changes. And so their splint needs to change period, right? So what the splint that might have worked when the arm was flacid or when There were no contractures. Maybe it worked then, but then now fast forward, 6, 9, 12 months, I, your patients who have strokes should be encouraged to come back to you six months a year.
[00:23:45] These injuries don't go away. They're managed over time, right? They're, they might need a new splint. They're trying to shove their hands and their arm into something that no longer fits. [00:24:00] Does anyone get what I'm saying? Any agreement, disagreements tell me, let me know, right? You can leave me a comment, you can message me.
[00:24:08] But people with strokes, their hand changes. So should their split needs, right? And so that's where I wanna encourage you, like what do you need to make right? In terms of ortho cases, majority of the time I majority of the time think what custom splints, what custom orthosis do I need to make, provide, and then if that doesn't work or if it's easier for the patient in terms of cost or whatever reason, preference, then I will go to prefab In neuro cases, in stroke cases, I tend to be the opposite.
[00:24:46] I tend to look at what prefab orthosis work really well or could work really well for them. And then if those don't fit, I can't get them, they don't wanna buy them, then [00:25:00] I will go into making a custom. And here's why I do it. I do it because there's some really great products out there.
[00:25:08] And each hand is different. So sbo I've worked with SBO in the past. I've seen it work for people. SBO Pro. They produce really great products for people with strokes, right? I would consider them, I would consider a prefab a resting hand splint, let's say if from a passive standpoint they can fit into it.
[00:25:32] And then what's also really good about those prefab orthosis is that they're really sturdy. They have they're made, they say it's made with a thermo pap plast, but I think they're just made with a stronger thermo plast because they're so much hardier than or maybe it's just me with a thicker material that maybe I carry.
[00:25:51] I carry a certain thickness and then I carry thinner materials. So when it comes to stroke patients, I think the opposite. [00:26:00] I go for prefab first and for whenever it doesn't fit, then I go into what custom can I make for them, right? And in my case what do you make? What do you make?
[00:26:12] The resting hand splint, like that blue padded. I try to, and I tell them, I tell my patients, especially if I'm seeing them for the first time. I'm like, dude, bring all your splints. You got splints. Bring 'em in a bag. Bring 'em in a suitcase, bring 'em. I wanna see what you have.
[00:26:30] And then we could decide what's works and what's not. 'cause I'm not gonna just, I'm just gonna recommend one that dude's already got. And that it didn't work. Why would I recommend it again? You know why? Maybe there's just some minor changes I could make. That can still be beneficial, right?
[00:26:50] So what did I make for him? I didn't make, so his his wrist was really tight, painful. His mps couldn't go into flexion. His ipss couldn't go into extension. [00:27:00] His thumb was like stuck in his hand, right? Like I said, he had some burn issues. He had burns all down here, right? Voler coming right up to that crease.
[00:27:12] He had a burn. All a little bit along the roller palm, he had some on the radial side of the thumb. He had a little bit on the small finger and he had a bunch on the side. So anything that crosses right here too, it's gonna, it's gonna hurt. And also he, when I have people bring in their prefabs, they can tell me what they don't like.
[00:27:36] So then I don't repeat it. He was like the straps cut into me. Great. I'm gonna make sure if I make you something, my straps, I'm gonna check on that. Make sure it doesn't cut into you, right? Because it was cutting into his, his burn his scars, right? So what I ended up making for him, I ended up making him a wrist support orthosis.
[00:27:55] And this is why I always talk about how, risk support,[00:28:00] risk. Extension risk support. Orthosis is one of the number one disciplin you as occupational therapist needs to learn to make right. And it's because there's a multi multitude of uses and once you learn how to make that one, you can make a multiple different ones.
[00:28:22] Let me, oh, sorry. Oops, let me see this question. Is there a specific brand you recommend for prefabs? Specifically in the neuro patient population? I really don't, outside of Sable, outside of, 'cause Sable makes their products really specific for neuro cases, it doesn't always fit everybody, but they have some products.
[00:28:43] I, the functional, it's not a brand, but you can get it on. Performance health, you can get it on, how do you call it? North Coast, right? Those are the two major, I think the two major brands that sell a lot of medical, like very therapy related.[00:29:00] Meyer pt, I think they sell it to. Those are the three essentially that, that companies that I know that you could order from people are buying their shit on Amazon, right?
[00:29:09] People are just buying their shit on Amazon. You can go resting hand splint and see what kind you get. And some of it's just guessing, right? Patients are guessing. Let me tell you, patients are guessing what they need and then they order it, right? You as a specialist, you don't have to guess because you understand splinting principles, you understand nature injury.
[00:29:33] And then all the considerations for putting those things together. Applying what you know as a therapist to help your patients. So if I can't help him get more motion, if his joint is stuck, I cannot get him more functional if his joints and any kind of movement hurt. So if I, am guessing myself, then [00:30:00] you know who's being helped here, and this is why I say it's so important as an occupational therapist, you have to understand your why.
[00:30:08] You have to understand the considerations, the principles, the needs, how to explain the why of what you're doing, right? So I picked a rest, a risk support splint, so maybe. Maybe we could have made a static progressive to bring his mps down to straighten his ips. I could have put him in a prefab, but let me tell you, if you put him in a prefab 'cause it's.
[00:30:35] The way his fingers were. 'cause I showed them what not to do, right? I took that splint that he had and I put it on, I tried to change it and modify a little bit and say, let me see if I can modify it to bend the mps. And what it did was, because his ips were so flexed it put a lot of pressure.
[00:30:55] Into mp, hyperextension, IP [00:31:00] flexion. So then you develop a deformity of the hand because he's, he from a ligament standpoint, he could not flex, right? But he can extend. So your body will move into the direction that it has the most ease. So it's easy to go into hyperextension here and it's easy to go into ip flexion here, and then the wrist is like this.
[00:31:24] So who's seeing this kind of hand in your neuro patient population, right? So you gotta fix the wrist. And once you fix the wrist, then you can go to the fingers. But sometimes we get too carried away and trying to fix everything all at one time. Listen, I'm saying things that I am guilty of, right?
[00:31:41] I'm not pointing the fingers. Fingers. Points it right back here, right? I have been guilty of saying, oh my God, I can do this. Let me fix you, right? Let me fix this because we. As healthcare, I think as OTs like, we just so desperately wanna help people, but sometimes we have to break it [00:32:00] down a little bit further.
[00:32:00] So I said I actually can't do more, I'll do more damage if I think too far ahead. So let me pull back. So I explained, so I decided what to make. I made a risk support orthosis. I explained why and I explained it based on the hand. Issues of finger contractures that I was faced with and that he had.
[00:32:19] So what I did was I made a wrist support splint so that his caregiver and his spouse could control his wrist and better easily manage range of motion of his fingers and the patient as well. So if I can control one component so they don't have to control it a k a, the risk, then they can stretch out the ipss.
[00:32:42] They can stretch it out. So they can push the MP into flexion. They can pull the IP into extension. He has scars. They can massage his scar, his thumb, they could, if you control the wrist, you can control the thumb. So you can pull the thumb out. If you can't control [00:33:00] the wrist, you can't control the thumb.
[00:33:03] All right, so there's dynamics to that. I decided what to make. I explained to them why I was making what I was making, and then this is what I'm looking for in terms of progress. By the time you come back to me next I wanna see, and I couldn't get his wrist as much into extension as I wanted.
[00:33:19] 'cause his tone will kick in. And that's the other thing, if you're putting all these components and the tone kicks in, they're fighting against. The splint and then you're going to have problems. And so I was like, these are things that you wanna look for. Don't pull on him like this. Or, so here's what I'm looking for.
[00:33:34] These are the problems that I'm. That we might be facing, and these, this is the progress that I'm looking for. So you wanna get real specific when you're, again, when you're making these orthosis prescriptions of what they should be doing, how often are they wearing it? If I don't include the fingers and I control the wrist, can I get you to functionally use your hand a little bit?
[00:33:56] That's the thing with those with those resting support [00:34:00] splints that. Put all the fingers on lockdown, if they're, the connection from the brain to the hand is done through movement and action, you just strap the whole shit down. How are they supposed to move? You have absolutely no motivation to move your shoulder, elbow, forearm when your hand is not working or your hand is shut down and it cannot move.
[00:34:22] So I want you to keep those things into consideration, right? And when to discharge, change or modify. So for him, I'm not necessarily discharging it, but I'm hoping that I can change it. So if I can control his wrist and get it less painful and I can pull on, maybe I will add components where he can actually pull down on his mps better.
[00:34:44] So if we can pull down his mps better, then he can just focus on straightening the ipss. So I'm just taking you through a little bit of my thinking process my critical thinking decision making process, because I think that's the, before you go to make anything, you [00:35:00] have to think about those things.
[00:35:01] And right now, if you are if you're new to the game of hand therapy, if you're like, don't have a ton of experience with splints. Like it, it may seem really overwhelming, but if you can break it into chunks of what you do, it can make it a little easier. So the critical thinking process is over here.
[00:35:20] And the making part and process is over here. And then as you get better with those two components, then over time they melt. And the process of critically thinking through your case gets faster and faster. It just takes time and practice. It really does, takes time and practice.
[00:35:37] Been doing it for 20 years over 20 years. And so that's why some people look at me and oh, how did you come up with that? Shit just didn't come up, out of nowhere. I've been practicing it and I've been breaking it down since I've been teaching it. How I can help you to simplify that process.
[00:35:54] A lot of us a lot of therapists, like especially me when I was coming up they knew what they knew and they locked it [00:36:00] down, right? They locked it down in their brain and unless you had a really good. A person that you worked with that was motivated to help you? Y you got the benefit of that, but what was that 1%, right?
[00:36:13] Like very few. So there's a lot of us now, and I think that times have changed. Technology has made it easier for us to join live, and go on live. I'm on Instagram I'm on YouTube, I'm on u I'm on Facebook. So you know, I can reach more people and I can share. Like how it works so that you too can learn how it works and break it down for your people.
[00:36:36] Because I really do think that neuro population, it matters. Those people need a lot of care and they need a lot of care for a really long time. It kind, it's always bothered me that as like cgs they discount that group, but that group is so important of people that you can help in terms of, what kind of splints they need.
[00:36:52] 'cause they probably need some kind of splint at some point always in their lives. And so I think that and it's a group of people that we can always continuously help. I know [00:37:00] insurance will be like you've plateaued. But I can tell you right now, knock on wood, if I had a stroke, I wouldn't want any fucking therapist to give up on my ass.
[00:37:09] If my, family member, I have a stroke, I would not want anyone to give up on their ass either. So that's just my. My take on it. And I think that, people with stroke have a lot to fight and just the same as people with life changing injuries that we work with have a lot to fight.
[00:37:25] And I think we have an opportunity to really be there and be the expert to help them. Because there's only so much that people can learn. On YouTube when it comes to these type of things that's why there still needs to be an expert that someone comes to to say for my particular case, what do you think I should do?
[00:37:46] So for my particular case, what do you think I should do? And those things might change from patient to patient. For stroke patients, they change from month to month, year to year, based on their injury and based on Based on the [00:38:00] changes of their recovery, there's reasons, right? You as a therapist, you need to know the reason why.
[00:38:08] It has to make sense. It has to make sense. And when it makes sense, your patient understands not I will pay whatever it is. Hu tell me the price. I'm gonna pay it. Okay? This is what I think you need. You can go. And get it for $25, but here's why you should pay my premium price. It's the same. It's, but I'm saying it not for my benefit.
[00:38:33] I'm saying it for their benefit. And there's the intention, you and I said that to him. Those are, you can go online, get a large, extra large, buy a couple of 'em, try and return it. But I can tell you why that isn't gonna be as good as the one I make you. And if I didn't make it I. Bring that shit back, let's go again.
[00:38:54] But those are the things that I want you to really, think about. I am [00:39:00] actually going to go into so much more detail during my two hour. I'm doing a two hour. Orthosis workshop. It's, I'm going live 'cause a lot of my members in my program join in and stuff like that.
[00:39:13] But we will be going live for two hours Saturday, August 5th. And what am I gonna do? I'm gonna talk about, I. Print like splinting principles. I'm gonna share even more tips. I'm gonna show you finger splints, hand splints. I'm gonna show you what I do when there's, when you're. When you're limited, right?
[00:39:35] When you're limited can, because it comes, it really honestly, it comes down to your ability to critical think and make decisions. Because sometimes I've worked with students in my program who just don't have split material. They have limited. Splint material. What are some of the things that you could do?
[00:39:50] As long as you take into and long as you understand the principles of splinting and then considering certain injuries you'll [00:40:00] be able to make better decisions. On what your patients need. So that's gonna be August 5th. Y'all people are gonna be getting emails from me, from my students. I'll be sending you emails.
[00:40:09] And then we'll go into I'll do some demonstration and then we'll go into questions and stuff like that. So if you're wondering how you can get access to this orthosis workshop, feel free to send me a message and I'll send you some details about it. But I think it's I know it's gonna be good.
[00:40:25] I always get hyped up for these things, but it's definitely for the members in my program. August 5 12:00 PM Eastern Standard Time. You'll get 24 hour reminder. One hour reminder and it will be recorded for your viewing pleasure later. 'cause sometimes I know there's a lot to say and there's a lot to remember.
[00:40:44] So this is one of the reasons why all my calls are recorded. And that way you can, go back to certain chunks of it and re-listen. So one of the things I do when I take online classes I sometimes if I hear something good, I'll mark down what time, like the time so I can go back to [00:41:00] it.
[00:41:00] So Jen, that's a good one for you. If you if you hear something, you're like, oh, I need to know what she said again. So in my, for my students, I also do, when they send me questions and I need to explain it beyond words, I'll make little loom videos for them. So a little five minute video.
[00:41:14] Sometimes they're a little bit longer. I really try to keep it short when I'm explaining things. But I will always tell them like, this part is an important part. Go back and listen to the words that are coming out of my mouth. And then once you hear that a little bit, then you will turn them into your words.
[00:41:32] So if you wanna rewatch this or you're watching for the first time go back to here. Where were some key points Juan was talking about? When it comes to prescribing orthosis, when it comes to explaining why your patients need this, and the way it helps you is that you get better and better at that understanding.
[00:41:57] And if you listen, if you're If you're considering [00:42:00] becoming a certified hand therapist and you wanna study for the exam and stuff like that, splitting is a key component during study and application I. Right during study, and most importantly in application, you can memorize all the shit you want, but if you don't know how to apply and you don't know how to make a decision, you'll fail that test every single time outside of that test.
[00:42:28] If you don't take the time to learn how to critically think and make decisions. It's going to be hard for you to feel like a competent, independent therapist, right? And in this day and age, you need to be confident, competent, and be the person that your patients turn to for recommendations, advice, what to do instead of just being like, Go ask your doctor because I'm gonna tell you what my, some of 'em doctors don't know.
[00:42:58] They know their scope of [00:43:00] practice. You as occupational therapist, you need to know your scope of practice, right? So anyway, I'm excited next Saturday. If you guys have any interested in joining me for the orthosis workshop send me a message. I'll let you know how you can get access to it. Otherwise, Until the next LIve.
[00:43:21] Thank you so much for joining. If if it really helped you, can you share with someone that you know? Maybe they need this too. All right. Thanks so much. Enjoy your weekend. Bye. Hey, therapy friends, it's Wong here. Thanks again for watching my video, and if you like videos like this that can help you just crush it in the hand therapy world as an occupational therapist, then hit the subscribe button and enjoy the video.
[00:43:43] Thanks again for watching.[00:44:00]
