OOrrtthhoottiicc DDeessiiggnn aanndd FFaabbrriiccaattiioonn ffoorr tthhee UUppppeerr EExxttrreemmiittyy AA PPRRAACCTTIICCAALL GGUUIIDDEE Longitudinal transverse arch Proximal transverse arch Distal transverse arch KKaatthheerriinnee SScchhooffiieelldd •• DDeebboorraahh SScchhwwaarrttzz SSLLAACCKK IInnccoorrppoorraatteedd Katherine Schofield, DHS, OTR/L, CHT Assistant Program Director and Associate Professor Department of Occupational Therapy Midwestern University Glendale, Arizona Deborah Schwartz, OTD, OTR/L, CHT Product and Educational Specialist Physical Rehabilitation Orfit Industries Antwerp, Belgium Adjunct Professor Department of Occupational Therapy Touro University New York, New York Senior Vice President: Stephanie Arasim Portnoy Vice President, Editorial: Jennifer Kilpatrick Vice President, Marketing: Michelle Gatt Acquisitions Editor: Tony Schiavo SLACK Incorporated Managing Editor: Allegra Tiver 6900 Grove Road Thorofare, NJ 08086 USA Creative Director: Thomas Cavallaro 856-848-1000 Fax: 856-848-6091 Cover Artist: Katherine Christie www.Healio.com/books Project Editor: Dani Malady © 2019 by SLACK Incorporated Dr. Katherine Schofield has no financial or proprietary interest in the materials presented herein. Dr. Deborah Schwartz is a full-time employee of Orfit Industries America, a manufacturer of thermoplastic materials. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher, except for brief quotations embodied in critical articles and reviews. The procedures and practices described in this publication should be implemented in a manner consistent with the professional standards set for the circumstances that apply in each specific situation. Every effort has been made to confirm the accuracy of the information presented and to correctly relate generally accepted practices. The authors, editors, and publisher cannot accept responsibility for errors or exclusions or for the outcome of the material presented herein. There is no expressed or implied warranty of this book or information imparted by it. Care has been taken to ensure that drug selection and dosages are in accor- dance with currently accepted/recommended practice. Off-label uses of drugs may be discussed. Due to continuing research, changes in government policy and regulations, and various effects of drug reactions and interactions, it is recommended that the reader carefully review all materials and literature provided for each drug, especially those that are new or not frequently used. Some drugs or devices in this publication have clearance for use in a restricted research setting by the Food and Drug and Administration or FDA. Each professional should determine the FDA status of any drug or device prior to use in their practice. Any review or mention of specific companies or products is not intended as an endorsement by the author or publisher. SLACK Incorporated uses a review process to evaluate submitted material. Prior to publication, educators or clinicians provide important feedback on the content that we publish. We welcome feedback on this work. Library of Congress Cataloging-in-Publication Data Names: Schofield, Katherine (Katherine A.), author. | Schwartz, Deborah (Deborah A.), author. Title: Orthotic design and fabrication for the upper extremity : a practical guide / Katherine Schofield, Deborah Schwartz. Description: Thorofare, NJ : Slack Incorporated, 2019. | Includes bibliographical references and index. Identifiers: LCCN 2019008424 (ebook) | ISBN 9781630915919 (epub) | ISBN 9781630915926 (web) Subjects: | MESH: Orthotic Devices | Upper Extremity | Equipment Design Classification: LCC RD557 (ebook) | LCC RD557 (print) | NLM WE 26 | DDC 617.5/7--dc23 LC record available at https://lccn.loc.gov/2019007687 For permission to reprint material in another publication, contact SLACK Incorporated. Authorization to photocopy items for internal, personal, or academic use is granted by SLACK Incorporated provided that the appropriate fee is paid directly to Copyright Clearance Center. Prior to photocopying items, please contact the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA 01923 USA; phone: 978-750-8400; website: www.copyright.com; email: [email protected] Please note that the purchase of this e-book comes with an associated website or DVD. If you are interested in receiving a copy, please contact us at [email protected] Dedication I dedicate this book to those in my life who encouraged me along the way. This includes my husband, Dale; my sons, Austin and Andrew; my mom, Gretchen; and my sister, Lisa. Thank you for having faith in me. —Katherine Schofield I inherited my love of writing from my father, Bernard Shuman. My brother, Ellis, shares this passion as does my hus- band, Barry. I dedicate this book to Barry, who encourages and inspires me everyday, and to my children, Nadav, Talia, and Noam, who have offered me multiple opportunities to practice orthotic fabrication. —Deborah Schwartz Contents Dedication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Part One Foundations of Orthotic Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Chapter 1 Orthotic Fabrication: Principles and Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Chapter 2 Anatomical and Biomechanical Principles of Orthotic Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Chapter 3 The Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Part Two Orthoses as Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Chapter 4 Wrist Immobilization Orthoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Chapter 5 Wrist and Hand Immobilization Orthoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Chapter 6 Forearm- and Hand-Based Thumb Orthoses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Chapter 7 Elbow, Wrist, and Hand Immobilization Orthoses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Chapter 8 Hand-Based Orthoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Chapter 9 Digit-Based Orthoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Part Three Advanced Orthotic Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Chapter 10 Orthoses for Tendon Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Chapter 11 Orthoses for Mobilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .227 Prefabricated Immobilization Orthoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 Acknowledgments I am so grateful that Deb agreed to work with me on this endeavor. I found a knowledgeable, passionate individual who loves teaching and making orthoses as much as I do! Thank you, Deb, for all of your support, perseverance, tenacity, friendship, encouragement, constructive feedback, and hard work. This would not have been possible without you! Thank you Brien Cummings and the wonderful staff at SLACK Incorporated for supporting us through to the end of this long journey. Thank you to my colleagues and mentors at Midwestern University in Glendale, Arizona, for their unending encour- agement. I am blessed to have the opportunity to teach and inspire my occupational therapy students on a regular basis, and I am eternally grateful for their ongoing support and excitement about this project as it progressed. A special thank you to Jack Mullins and Jason Tinsley for their expertise and patience with video production; Dr. Chris Merchant for her support and encouragement; and Dr. Tana Brown for her suggestion that I needed a “project” to work on. I also wish to express my gratitude and appreciation for my occupational therapy students: Allie Cammarata for her hard work and tireless attitude drawing all of our custom illustrations; Callie Surridge for having her camera ready for our photos; Carson Lund for his suggestions and help during our video shoot; and Brianne Van Buren and Cassie Durfee for their time and willingness to assist with our videos and photos. —Katherine Schofield Thank you to my wonderful writing partner and colleague, Katherine, for inviting me to join you on this creative journey. Thank you to SLACK Incorporated and Brien Cummings for picking up the ball with this project. Thank you to Orfit Industries for donating thermoplastic materials for our orthotic fabrication videos and for use of photos. —Deborah Schwartz