Expert opinion on splinting adult patients with neurological injuries

Abstract

In the light of a lack of research evidence, this study explored expert opinion for splinting in adults with neurological injuries. An exploratory, descriptive, qualitative methodology was used with 14 occupational therapists, experienced in neuro-rehabilitation. Data were analysed based on a priori themes from two models of clinical practice:- • The Model of Practice Development: - themes indicate that most value was placed on personal knowledge gained from experience in the field and being able to individualise treatment for each patient. Procedural knowledge gained from clinical experience; reflection on protocols and working with and learning from others were seen as essential in developing skills required for splinting in adults with neurological injuries. • The Three Track Model of Clinical Reasoning: - Themes indicated that the effectiveness of the splints depended on the patients' context and response as well as the therapists' ability to adapt to their preferences and goals. Procedural reasoning and goals related to client factors should not be considered in isolation and each patient must be considered individually when prescribing splints. Considering the patients' context and the support and resources they have, is also essential. Outcomes in adults with neurological injuries should consider occupational performance and client satisfaction when evaluating effectiveness of splinting. Key words: Splinting, Adults with neurological dysfunction or conditions, Clinical reasoning, Professional development

Occupational therapy upper limb splinting practice for clients with acquired brain injuries: A cross-sectional study from South Africa

“…The components highlighted by Chazen and Franzsen (2016) support the work of Kuipers et al (2006) and Rassafiani et al (2008) who highlighted factors relating to the client, the therapist and the environment, all of which could fall under each type of clinical reasoning. Chazen and Franzsen (2016) further highlighted that effective splinting for neurological conditions is dependent on a clear understanding of the client's background and context, and that a problem-solving process be utilised to consider all factors in order for splinting to be effective. These authors provide insight into the clinical reasoning employed when working with clients with ABI and splinting, However, their study results are not generalisable to the larger South Africa context given the limitation of the small homogenous sample of practitioners working in private practice and academia in one province.…”

“…As and when a client progresses through the stages of motor recovery, the use of the splint and its purpose should be continually re-evaluated. As reflected in the results of this study, splints are used more in the earlier stages of motor recovery than the later stages., and it can be noted that once the client starts to show recovery, the splint should either be removed or it should be adjusted to enhance functional use of the hand and upper limb in daily activities (Chazen and Franzsen, 2016;Gillen, 2016).…”

“…Data were collected via self-administered questionnaire that contained three sections and was developed according to the format used by Walker et al (2000Walker et al ( , 2003 and de Klerk et al (2015). The questionnaire items were formulated using studies on the clinical reasoning informing the use of splints for persons with an upper limb condition following an ABI; the factors that influence the decision to use splints or not, as well as existing literature on the use of splints, the types of splints and the splint regimens (Chazen and Franzsen, 2016;Kuipers et al, 2006;Rassafiani et al, 2008). Items were further informed by the objectives of the study.…”

Bridging the Gap between Clinical Service and Academic Education of Hand-Splinting Practice: Perspectives and Experiences of Thai Occupational Therapists

“…Hepworth et al [ 30 ] found that hand splinting in children with a neurological impairment requires knowledge of the condition (92.5%), experience (82.5%), competency (80%), and available resources (75%). Similarly, Chazen and Franzsen [ 33 ] evaluated the opinion of experts regarding splinting adult patients with neurological conditions, who reported that occupational therapists should develop skills in fabricating splints and learn from others’ experiences with clinical practice.…”

Current U.S. splinting practices for individuals with cervical spinal cord injury

“…Our findings indicate splinting guidelines should not be rigidly prescriptive, but instead stem from a conceptual, clinical, and reasoning framework. Therapists with less clinical experience may seek out and follow established splint protocols, while more experienced therapists are more likely to create individualized splinting programs [12]. Clinical decision making references practice guidelines, but it is critical to realize each client is unique.…”