Brief or new: two pronation splints.

For two years we have made pronation splints to assist quadriplegic patients who lack adequate forearm pronation but who have enough upper extremity strength to feed themselves and perform other self-care or functional activities. We have found the splints to be an appropriate alternative to the MAS. The first pronation splint fits underneath the arm, is simple in design and fabrication, and is hidden. However, occasionally the lever of the splint hangs up in the shirt, catches on the post of the wheelchair, or slips out from underneath the arm when the patient reaches away from the body. To eliminate these problems, we designed a second splint. But, this splint requires more time to make and adjust, has two parts to put on instead of one, and is more noticeable because it is worn on top of the arm rather than underneath it. When a patient uses either splint, the degree of pronation may be adjusted according to the activity by slightly rotating the splint either way when strapping it on. For example, full pronation may be required for feeding, but only half the range is necessary to operate the keyboard of a computer or typewriter. Once the Velcro straps are applied, the splints do not slip. The splints are not interchangeable from left to right and assistance is always needed to put them on. For patients with "weak" or "absent" wrist extensors, a wrist support and cuff splint may be used along with the pronation splint or a universal cuff, if wrist extension is adequate. The pronation splints are appropriate for those patients whose forearms supinate when they reach their hand to or near their mouth.