28 November 2013

Therapy from Scratch

In the past few days I've inherited three new burn patients . . . two of which are pint-sized girlies with terrible burns to their hands.  One was caused by boiling water, the other by hot oil.

Selon moi, there is no worse injury than a burn.  It is incredibly painful and in some cases the healing process takes a year of compression therapy and several more of reconstructive surgeries and contracture releases.  For those with face and hand burns there are often psychological scars as well, as many struggle with self-image issues and social isolation.

On top of that, when a more severe burn injury crosses a joint, there are often functional deficits as a result.  As an Occupational Therapist, it's my job to do whatever I can to limit those deficits.  Using special hand splints, for example, is one way to help the thumb, fingers and wrist stay in a 'position of function', providing a continual stretch to certain bits of important anatomy in order to guard against tissue 'shortening'.

But those splints are expense.  And they don't exist in Niger.  And I've tried multiple different materials that have either been too strong we cannot mold them, too weak they don't hold the proper position, or too water-soluble we can't clean them.  But I'm happy to say, Plan D has finally worked!!

I'd wanted to try PVC for some time . . . but just never got around to it.

So when these two cuties came through our doors with their tiny hands in desperate need, I bee-lined to the Shop and found some scraps on the ground (don't worry!!!  I had permission to go scavenging!).

It took about an hour a piece for each pair, but in the end a piece of plastic plumbing pipe had been transformed into miniature positioning devices!

Not going to lie . . . I was proud of myself!

And not just because I made clam-digger burn-hand splints from scraps . . . but because I was working with a heat gun at 450°C (that's A LOT of Fahrenheit) and didn't end up a burn patient myself!!  Which, considering my fine-motor skills, I'd say I've earned a merit badge!!

I'm sure  you're all anxious to run out and find PVC bits in order to make your own burn-hand splints at home . . . so I've provided step-by-step instructions, complete with (very poorly taken) photos (hey!!  Don't judge . . . power tools, selfies and my history with fine-motor skills don't exactly go hand-in-hand!!):

1. Start with round pieces of PVC with a diameter
wide enough for the thickest part of the patient's
2. Mark a guide-line with a sharpie and cut your
PVC with diamond-bitted Dremel (every girl should
have one!) so you have two equal sized troughs.

3.  With the heat dial set to really, REALLY hot, begin to heat up the
concave side of the PVC.  As it begins to widen, flip it over and heat
it some more, belly-side-up until the edges fall flat against the
work surface.
Voila!!   Nice and flat! It's like magic . . . or more
like physics . . . neither of which I do on a regular
basis or typically with much success.
4. Trace your pattern onto the PVC (okay, I cheated
and used her hand against the PVC instead of
making a pattern . . . but I don't recommend you
try that at home!)  The most import part is that
little floppy-dog ear thing in the middle.  Make sure
you've marked the CMC joint, and make a
backwards-J up to the top of the thumb.  If you don't
know what the CMC joint is, maybe you should rethink
splint fabrication as a hobby.

5. Cut along the solid lines . . . they way you learned all those years
ago in Kindergarten.  You'll want to use a sandpapering attachment (not
pictured here)  on the Dremel to buff down the corners and smooth
out the edges . . . unless of course you don't cut like you're still in
Kindergarten, unlike me.

6. If you want to make bilateral splints, and you've gone
against medical advice and didn't make a pattern, be
sure to trace a second copy while it's flat!  Tracing in 3D
can get complicated . . . trust me . . . I speak from experience!

7. Being sure to wear gloves that will resist 450°C
for at least  a few seconds, start with the thumb flap.
Heat it up where it's still connected to the rest of
the splint, and curl it back against your index finger.

8. It's really important to have the MCP joints of the fingers at 90° so
pull out your trusty goniometer and measure.  Heat up only
the strip next to the thumb-flap so that your splint has a bending
point.  From here you will want to heat up the wrist to put it in
proper position as well. 

9.  We don't want the splint to fall off, so carefully round the edges by
heating up one side at a time and using your thumb or hypothenar
eminence (remember, heat resistant glove on), curve the forearm support.

Aren't they adorable!!  Little mini clam-diggers!!  I LOVE MY JOB!


Robin said...

So this is how you spent your Thanksgiving -- giving thanks that our wonderful GOD gave you brains to figure out how to do such amazing things with so little as to pay HIM back by doing for others!! May HE continue to protect you and your teamies and provide all the PVP and other items needed to minister to that people who so desperately need help......missing you and praying for all of you......oxoxox Mom

Leah said...

Oh my gosh, I love those, I love your initiative, and the fact that you know how to use those tools to do magic! (I was really hoping to see those on the little hands, since I do NOT know what the MCP and CMC joints are, though I have an idea--and I WILL be rethinking splint fabrication as a hobby.

Deb. said...

I wasn't able to put them on yesterday, as they took too long to make. Will do so today and post pictures here in the comments.

Deb. said...

Thanks mom! I know you're my biggest fan!

Deb. said...

Here's the finished product, applied. They've proved to be working well! As we can wash them each day and reapply them. Sent one through the sterilizer on Friday and it kept it's shape too!! PTL!! I think we've found the solution!!