Mediroyal Tonus Splint Instructions page 10

Instruction
GB
Mediroyal Tonus Splint
GB
Patients with neurological disorders often suffer from spasticity. The involuntary muscle tension
often changes rapidly and can be affected by external factors, both physiological as well as
psychological like anxiety, mood, lifestyle and pain. Poor hand positioning and instability of the
MCP-arch can also trigger more spasticity. The treatment philosophy of the Mediroyal Tonus
splint is to provide a good positioning of the hand in combination with providing an individual
dynamic wrist extension with the inflatable bladder. The inflation provides a slight pressure
under the MCP-joints to support the arch and to extend the joints which helps to extend both
the PIP- and DIP joints. The aim is to provide constant and even stretch over the flexor tendons
in order to make the stretch reflex less hypersensitive. Other functions are to maintain passive
wrist extension, support weak muscles, stretch contractures and pressure prevention. The
upper extremity is a chain of joints starting from the shoulder all the way down to the DIP-joint of
the fingers. It's important to assess all joints of the patient in order to get the maximum effect of
the treatment. Combinations of different orthotic solutions are often the most efficient treatment.
Under point 11 you can find some more information on how to combine other types of orthoses
in the treatment.
1. General information · Read the instruction carefully. The product should be fitted by a
medical professional like an occupational therapist, physical therapist, orthopedic technician or a
medical doctor. Patients with diabetes, circulatory problems or sensitive skin should consult their
doctor before use. If the patient is allergic, check the material content on the textile label.
2. Indications · The product has been designed to provide tonus reduction and positioning of
the hand for patients with spasticity like CVA/Stroke, Multiple sclerosis or traumatic spinal cord
injuries.
3. Contraindications · Patients that might increase spasticity by volar stimulation might not
be able to use the Tonus splint.
4. Pre Application · To select the right size, take the width over the MCP-joints. If the patient
has a very high tonus, it might be beneficial to try to inhibit the spasticity before application.
Correct positioning of the shoulder, external rotation of the upper limb and a gentle extension
and stretch of the wrist and fingers might make application easier.
Evaluate the maximal extension that can be reached in the wrist in combination with the
positioning of the fingers. Maximal extension usually triggers more spasticity that's why it's
important to find the sub maximal position for each individual patient. The more extension that
is reached in the wrist, the less extension can be reached in the fingers. This is caused by the
shortening of the flexor tendons. The whole length of the flexor tendons have to be distributed
over the complete chain of joints from the lower arm, wrist to the DIP-joints. It's therefore a good
idea to slightly flex the wrist in order to be able to extend the fingers. To prepare for application,
start with deflating the bladder completely with the black tip on the pump. Then remove the wool
cover. Bend the platform in the wrist area, just behind the adapter of the bladder to allow flexion. In
order to prevent pressure from the end on the splint against the lower arm, bend the end slightly.
5. Ulnar and radial deviation · If your Tonus-splint is fitted with a rotation adapter under the
bladder you can adjust ulnar and radial deviation. The rotation adapter is easily identified by the
golden screws on the front part of the platform. Use the screwdriver included in the package.
Unscrew the golden screws slightly in order to rotate the adapter with the bladder. Don't adjust
the black center screw. Find the most suitable ulnar/radial deviation and then tighten the golden
screws in order to fixate the adapter. If further adjustment is needed, simply open the golden
screws and change the angle.
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