Other Considerations
1. Heating time
The time required to heat thermoplastic materials to a working temperature should be monitored closely because material left too long in hot water may become excessively soft and stretchy. Thinner materials and those that are perforated heat and cool more quickly.

2. Color of the material:
– Darker-colored splints tend to show less soiling and appear cleaner than white splints.
– Colored splints are easily seen compared to white splints and, therefore, useful in preventing loss in institutional settings.

3. Thickness of the material:
–  Thinner thermoplastic materials are commonly used for small splints and for arthritis and pediatric splints
–  A high degree of flexibility can take stresses repeatedly. Flexibility is an important characteristic for circumferential splints because these splints must be pulled open for application and removal.

SAFETY FIRST

Orthotic fabrication involves working with heat and sharp tools. Both require extreme caution and supervision around patients. This is especially important when children or cognitively impaired people are nearby.

– Tools such as utility knives and scissors should not be left unattended on the table or countertop. Heat guns should be pointed away from people and objects when on, and should never be left running unattended. Make sure to close splint pan lids when you walk away.
– Always check the temperature of heated material prior to placing it on your patient to prevent a burn or discomfort. Remember that the splinting material holds heat.
– Splinting materials shrink slightly as they cool. During the molding and cooling time, precautions should be taken to avoid a shrinkage-induced problem such as difficulty removing a digit from a circumferential component of a splint.
– Remember to preheat thicker materials prior to cutting to avoid injuring your hands from the force and strain that will be required to cut the material.
– Remember to use the principles of good body mechanics and ergonomics. When fabricating an orthosis on a patient, avoid leaning excessively over the table or awkwardly over the patient. These positions put a lot of strain on your back and neck.
* Always try to obtain easy access to the patient’s extremity.
* Use gravity to assist you in orthotic fabrication by letting the material rest on top of the extremity as opposed to holding it up and in place.
– Remember to round all corners of the orthosis and all corners of the straps. Besides giving the orthosis a finished look, it is important to prevent sharp and pointed edges from scratching your patient.
– Foam and adhesive-backed padding materials are available for placement inside the orthosis and are often applied for comfort over bony prominences. Make sure to stretch the thermoplastic surface to create space for padding. Adding padding without creating space for it will increase pressure on a bony prominence, which is exactly what you want to avoid.

COMPLIANCE

A well-made orthosis is the key to successful outcomes and improved compliance. The goals of the orthosis will only be met if the orthosis is worn according to plan.

1. It is essential to explain the purpose of the orthosis to your patients. Make sure your patients understand the benefits of wearing their orthosis as well as the risks of non-adherence.
2. Explain what activities are (not) allowed while wearing the orthosis.
3. Follow up with patients regularly to encourage their adherence to the prescribed treatment plan. Continue to check for a comfortable and well-fitting orthosis.
4. Allow the patient some say in the design and/or color of the orthosis.
5. Make sure they are aware of the wearing schedule and know the expected time frame for achieving results.
6. Document the patient’s agreement with the treatment plan and keep a record of the schedule in writing.
7. Have the patient keep a record of their wearing schedule at home.

Example of a splint wearing schedule