The influence of splinting on healing tissues.

In addition to immobilizing injured soft tissue to allow healing, splints are used to positively influence collagen remodeling through the application of low-load forces to healing or contracted soft tissue, permitting soft tissue growth and concomitant increased function. When correction of limited passive range of motion due to soft tissue contracture is needed, splinting is an absolute requisite. No other currently available modality is able to hold a constant low-load tension for a prolonged time sufficient to cause tissue growth.

Reliability of the manual dynamic mode of the Baltimore Therapeutic Equipment Work Simulator.

Twelve Baltimore Therapeutic Equipment Work Simulators (BTEWS) were tested for consistency of resistance in the manual dynamic mode using a previously described timed weight-drop test. Fifty weight-drop measurements were made at five different weight levels: 5, 10, 20, 30, and 40 lb. Alterations in weight-drop times indicate changes in exercise-head resistance. Substantial resistance variation was found in the manual dynamic mode. With console resistance set consistently at 92% of applied weight, weight-drop times varied from failures of the weight to drop to times that were not recognized by the electronic timing system. Measurable weight-drop times ranged from 0.75 to 16.97 seconds. Ten Simulators had weight-drop times greater than +/-3 standard deviations (SD) from the mean; eight Simulators had times +/-4 SD from the mean; and four had times +/-5 SD from the mean. Console printout data did not accurately reflect resistance produced by the exercise head. While intermachine correlations based on Simulator printout data ranged from +1.0 to +0.9906, correlations derived from resistance-based weight-drop times ranged from +0.9866 to -0.9956. For a constant externally applied torque, the weight-drop times should have been constant but were not. Resistance produced in the manual dynamic mode is inconsistent, both within and between machines (p = 0.0001).

Threshold detection and Semmes-Weinstein monofilaments.

Semmes-Weinstein monofilaments provide a repeatable instrument stimulus with a small standard deviation in contrast to other handheld test instruments, making them an optimum choice for objective sensory testing in a variety of clinics. Normal sensory detection thresholds for the entire body, and the stimulus force for each filament, were determined by Weinstein. He found a nylon filament of 0.005 in wide and 38 mm long (mean force, 68 mg) to be a good predictor of "normal" light touch-deep pressure threshold for the hands and most of the body. However, manufacturers of the nylon used in making the filaments allow an 8-10% tolerance in diameter. This small change in diameter can result in small variations in mean force among filaments of a given size. It has not been previously determined what effect this small variance in force has on the accuracy of the 2.83 (marking number) 0.005-in wide filament most often used for normal threshold detection. This study compared the 2.83 filaments available at the Gillis W. Long Hansen's Disease Center, which have a mean force of 62 mg, with those from North Coast Medical, Inc., which have a mean force of 95 mg. The filaments were used by 6 examiners in a standard testing protocol for the hands, arms, faces, legs, and feet of 130 subjects. Heavier and lighter filaments of measured force were also included. Results showed a high correlation in responses for two values for the 2.83 filaments in the range specified. On detailed analysis between kits there were some differences for site and age.(ABSTRACT TRUNCATED AT 250 WORDS)

Splints: mechanics versus convention.

Splints are specialized engineering machines that are created to solve specific upper-extremity problems. Astute manipulation of mechanical concepts increases splint efficiency, enhances patient comfort and function, and improves splint durability, while diminishing cost and frustration. Creation of splint designs should be based on mechanical fact rather than on mode-of-the-day bias. Those who are responsible for the treatment of upper-extremity dysfunction and use splinting as a treatment modality must have a thorough working understanding of the engineering concepts involved. Splinting is both science and art but the ultimate criterium is does it work mechanically? If a splint does not work mechanically, then there is no reason for its application. The insight provided by understanding engineering concepts opens new horizons in patient treatment for those who take the time to learn.

Evaluation of impairment of the upper extremity.

Evaluation of impairment of the upper extremity is the product of a team effort by the physician, occupational therapist, physical therapist, and rehabilitation counselor. A careful recording of the anatomic impairment should be made because this is critical in determining the subsequent functional activities of the extremity. The measurement criteria for clinical and functional evaluation includes condition assessment instruments. Some assess the neurovascular system, others assess movements including the monitoring of articular motion and musculotendinous function. Sensibility assessment instruments measure sympathetic response and detect single joint stimulus, discrimination, quantification, and recognition abilities. A detailed description of each assessment is recorded and physical capacity evaluation is only one component of the entire vocational evaluation. This evaluation answers questions regarding the injured worker's ability to return to his previous job. The work simulator is a useful instrument that allows rehabilitation and testing of the injured upper extremity. Job site evaluation includes assessment criteria for work performance, work behavior, and work environment.