A comfortable orthosis is a must for improved patient compliance. Because, if your patient feels that their custom-made orthosis is uncomfortable, they simply will not wear it. Despite its necessity for optimum recovery.
Use these eight tips to make a supportive and comfortable orthosis. It will help your patient stick to the wearing schedule as outlined and have an optimal recovery.
1. Know your materials
Choose the most appropriate material thickness to match the intended target. Whenever possible, select the lightest material to do the job.
In addition, consider the size of the patient’s extremity and the material characteristics to make this choice.
In most cases you can consider the following material thicknesses for adult patients:
- Finger orthoses: choose 1.6 mm (1/16”) material or Orficast;
- Hand-based orthoses: choose 2.1 mm (1/12”) thickness or Orficast More;
- Wrist or elbow orthoses: choose 3.2 mm (1/8”) thick materials, e.g. Orfit NS or Orfit Eco.
2. Make a pattern to ensure a comfortable orthosis
Make an accurate pattern that matches the exact size and shape of the patient’s extremity. This will save you time and effort while fabricating the orthosis. Moreover, you can make sure that the orthosis is appropriately designed for your patient.
It will prevent:
- Having to stretch the material to fit, in case you did not cut it large enough.
- Having too much material, which can cause wrinkles.
3. Avoid pressure points during moulding
While fabricating the orthosis, be careful not to hold any part in place for more than a few seconds. Because each time you press into the material, you may create a pressure point in the final orthosis.
Try using the pinch method of circumferential orthotic fabrication. These methods allow your hands to be free of holding the material in place, and available for positioning.
This video demonstrates how to use the pinch method for an Anti-Swan Neck Orthosis:
4. Check the fit
After the fabrication is complete, assess the fit of the orthosis on the patient’s hand.
- Are the straps long enough?
- Are they placed in the proper places for a secure fit?
- Does the orthosis slide around on the patient’s arm? If it does, trim a bit more off the sides so that the straps secure the orthosis more effectively.
5. The perfect finish for a comfortable orthosis
Round off all corners and smooth all edges. This prevents sharp parts that might hurt during donning and doffing of the orthosis.
Find the perfect tools to finish your orthosis here.
6. Adjust where needed for a more comfortable orthosis
Are there any red marks along where the edges of the orthosis hit the forearm? Briefly stretch the material open to enlarge the sides or reheat the edges with a heat gun and flare away from the arm.
7. Take the pressure off
Does the orthosis place pressure over the bony prominences? In that case, you can use several effective techniques to adjust the orthosis for a comfortable fit:
Theraputty or thermoplastic material
Before moulding, place Theraputty or a small scrap of thermoplastic material on the bony prominences of the hand or arm. Then, fabricate the orthosis as you would normally.
After hardening, remove the putty or scrap of material from the inside of the orthosis. This process creates a small enlarged area.
Tip: Put some lotion on the putty or use a coated scrap of material to prevent sticking.
Heat potential pressure areas with a heat gun and flare the material outwards with your thumb. Make sure to keep your thumb in place until the material hardens. Otherwise, the heated area will collapse and cause even more pressure on the bone.
The lipstick trick
Use lipstick or a red marker to draw on the bony prominences. After moulding the orthosis, these marks will show on the inside of the orthosis. They indicate where you need to make adjustments.
8. Consider the orthosis’ position
Are you making a forearm-based orthosis? Then, the proximal edge should not hit the biceps muscle during elbow flexion. For hand-based orthoses, on the other hand, the proximal edge should not impede wrist motion.
Flare the proximal edge of the orthosis outwards slightly so that it does not dig into the arm.
These considerations and tips will enable you to fabricate a well-fitting and very comfortable orthosis. One that will help your patient with his or her recovery.
Taking the extra time to do these steps will show the patient that you care.
Written by Debby Schwartz, OTD, OTR/L, CHT
Physical Rehabilitation Product and Educational Specialist at Orfit Industries America.
Debby is a certified hand therapist with over 36 years of clinical experience. She completed her Doctorate of Occupational Therapy at Rocky Mountain University of Health Professions in 2010. She has worked at Orfit Industries America as Product and Educational Specialist since 2007.
Debby is also an adjunct professor at the Occupational Therapy Department of Touro College in NYC and has written many book chapters in the field of hand therapy and multiple articles for hand therapy journals, including the ASHT Times and the Journal of Hand Therapy. She has published a new textbook on orthotic fabrication together with Dr. Katherine Schofield, entitled “Orthotic Design and Fabrication for the Upper Extremity: A Practical Guide”.