CLASSIFICATION OF HAND SPLINTING

KEY TO OCCUPATIONAL THERAPIST

Terminology:

# SCS-Splint Classification System

# ASHT-American Society of Hand Therapists

The terminology in describing splint or orthosis has been reviewed but there is no one single system adopted universally.

Joint efforts by doctors, therapists and orthotists had been set up to review the classification of splint.

Four ways of classifying hand splints have been introduced namely,
eponym,
acronym,
descriptive classification system and the

classification system proposed by the American Society of Hand Therapists.

There was a debate in 1989 by ASHT’s to discuss the issues regarding the nomenclature system for splints.Historically, there were a number of splint classification systems, including grouping according to

purpose,
configuration,
mechanical properties,
material and
anatomical site.

However, every approach has its own strength and weakness.

Fig.ASHT Class.System

The art and craft of the hand splinting are the responsibility of the occupational therapists and may be referred as Architect of the splint.

These splints are designed based on the individual needs and it should not be any hindrance to their occupation. These systems include the use of rote memory or logical deduction in grouping of splints.

Descriptive system of classification:

This system provided a more descriptive means of grouping splints based on three criteria:

1. the types of splinting forces employed and the spatial planes in which they occur,

2. the anatomic site of emphasis, and

3. the primary kinematic goal of the splint.

When describing a given splint, one can use three adjectives to delineate the “how”, “where”, and “why” of the splint.

The Descriptive Classification System provides more details and rationales of the splint. However, there is no rigid format, making the system difficult to follow. This will induce discrepancy in communication.

ASHT-SCS System:

The ASHT-SCS first divided splint/orthosis into “Articular” and “Non-articular”, which are subdivided into “Location”. Since articular splints involve joint movement so it has additional dimension on “Direction” of movement, which includes “Mobilisation, Immobilisation and Restriction”

The “Direction” indicates the primary intended movement or non-movement taking place on the extremity, rather than describing movement or non-movement taking place on the splint itself.

The articular branch is further divided into “Type” according to the number of joint levels affected secondarily.
In contrast to the primary joints, secondary joints are included in a splint to provide counterforce control, position, or stabilisation of joint(s) immediately adjacent to primary articular structures within the longitudinal kinematic chain.
The total number of joints included in a splint is noted in brackets at the end
The use of “Type” designation has the advantage of providing more information and implication of the splint.
Splints involving the MCP, proximal interphalangeal (PIP) and/or distal inter- phalangeal (DIP) joints could have the indications as shown in Table 2.
The final level of SCS is the “Design Options”, which includes construction, traction type, force applied, etc. Since the style and design of a splint are of secondary importance in SCS, it is optional for including the design options in the splint name.

Example shown in the table :

Common name will be Wrist extension splint hereby according to ASHT-SCS the name will be Wrist extension immobilisation;Type 0(1)

The ASHT-SCS is a comprehensive system, which caters nearly all important aspects of splinting nomenclature, such as anatomical site, movement and design.However, it requires training for users to get familiar with the system.

The promotion of the system may be limited to members of the ASHT rather than other potential user.

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