Patent Document

TECHNICAL FIELD 
     The invention relates to maintaining the hand and or foot in reflex inhibiting positions to reduce hypertonicity. (increased muscle tone) 
     BACKGROUND OF THE INVENTION 
     Individuals with hypertonicity are at risk of developing joint contractures. splinting is designed to avoid the formation of contractures or control contractures that are already present. Muscles are stretched and elongated through therapy. Muscle length needs to be maintained following therapy. The use of a splint fabricated of a rigid thermoplastic material is ineffective with hypertonic individuals because it is nearly impossible to maintain complete contact between the hand and/or foot and the rigid thermoplastic splint. The thermoplastic splint does not allow for the movements that are obligatory in the upper and lower extremities due to primitive reflex patterns. 
     Many types of rigid splints have been used in an attempt to control contracture. These splints have generally not prevented wrist and finger contractures or toe grasp in the neurologically impaired patient. Continuous stretch with use of these rigid splints does not elicit the desired response of decreased tone and increased range of motion. Most thermoplastic splints are of volar design. Splinting the volar surface stimulates the flexor muscle group increasing the already excessive flexor tone in both the hand, wrist and/or ankle, foot. Often, patients complain of discomfort and do not tolerate rigid splints. 
     SUMMARY OF THE INVENTION 
     The Metacarpal, Phalangeal, Interphalangeal, Abduction, Extension, Wrist Extension, Mobilization, Muscle Tone Reduction Splint, Type 0 reduces hypertonicity in the hand and/or wrist. The Metatarsal Abduction, Mobilization, Muscle Tone Reduction Splint, Type 0 reduces hypertonicity in the toes, foot and ankle. Traditionally, preserving the longitudinal and palmar arches to provide functional hand position is the goal of splinting. However, in the severely, neurologically impaired patients with hypertonicity, there is little functional hand use. Issues with this population include: 1.Increased tone in wrist and finger flexors and finger adductors 2. Increased risk of contracture development 3. Skin integrity and 4. poor hygiene. Flattening of the palmar and longitudinal creases promote finger abduction. Finger abduction will relax the hand and reduce hypertonicity throughout the hand and wrist. Hypertonicity is decreased when tone in the Lumbricale and Palmar interossei muscle groups is reduced. Tone in the wrist and hand is reduced when the Lumbricale and Palmar interossei muscles are held in a prolonged passive stretch, while stabilizing the metacarpophalangeal joints. Relief of hypertonicity in the hand and wrist is the goal of the METACARPAL, PEALANGEAL, INTERPEALANGEAL, ABDUCTION, EXTENSION, WRIST EXTENSION, MOBILIZATION, MUSCLE TONE REDUCTION SPLINT, TYPE 0 . 
     When used on the hand, our device incorporates a fiber filled palm and finger cushion with a thermoplastic dorsal stabilization lid. The cushion is covered with a soft absorbent material to maintain good skin hygiene; the fiber allows air to pass through the cushion to the patient&#39;s hand. The cushion is gently positioned into the patient&#39;s palm, the flared end of the cushion is placed in the thumb web space. The three abductor pads that extend from the cushion are pulled between the index and middle finger, the middle and ring finger and the ring and the little finger. The dorsal stabilization lid provides metacarpophalangeal joint stability and ensures the finger cushion placement. The dorsal lid has a relieved area over the metacarpophalangeal joints to prevent skin breakdown and promote comfort. 
     Locking mechanisms between each finger allow the abductor pads to be secured into the dorsal lid at the metacarpophalangeal web space. A band attached to both ends of the palmar cushion is placed under the dorsal lid. If the inferior end of the dorsal lid requires stabilization, it can be anchored to the band secured to the palmar cushion. If necessary, a dorsal wrist and forearm component may be added to address excessive wrist flexion. This is also made of thermoplastic material. It is attached at the base of the dorsal lid. It crosses the wrist joint, covering ¾ the length of the forearm. It is secured at the distal portion with webbing. 
     Hypertonicity in the foot is characterized by a lower extremity extensor pattern, with increased tone in the toe, ankle and foot. The inversion reflex is triggered by pressure over the fifth metatarsal head. Pressure to the entire plantar surface of the metatarsal heads can result in toe grasp. The toe grasp reflex is demonstrated by marked increase of tone in the toe flexors and ankle plantarflexors. Relief of the toe grasp reflex as well as inversion and eversion reflex at the ankle is the goal of the Metatarsal, Mobilization, Muscle Tone Reduction Splint, Type 0. 
     The foot splint incorporates a resilient core material encased in an absorbent covering, secured with a series of hook and loop fastener. The device is placed under the ball of the foot with the metatarsal heads and lessens tactile and proprioceptive input into reflexogenous areas of the foot in the neurologically impaired patient. Hypertonicity is decreased when tone in the Interossei muscle group is reduced. Tone in the ankle and foot is reduced when the abductor muscles of the toes are held in a prolonged passive stretch while stabilizing the metatarsophalangeal joint. The soft strap that extends from the metatarsal roll is connected with a hook and loop fastener across the dorsum of the foot, just distal to the metatarsal heads. The four abductor pads that extend from the metatarsal roll are gently positioned between the great toe and the second toe, the second toe and the third toe, and the third toe and the fourth toe. Each abductor cushion is attached to the dorsal strapping using hook and loop fastener. The toes are held in abduction and the metatarsal joints are stabilized. This decrease of abnormal muscle tone, results in: decreased medial or lateral deviation of the forefoot which reduces toe grasp, reduction in inversion or eversion at the ankle and a decrease in ankle plantar flexor tone. When used in combination with an ankle foot orthosis, there is further tone reduction throughout the lower portion of the leg. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     The presently preferred embodiment of the invention is disclosed in the following description and in the accompanying drawings, wherein: 
     FIG. 1 is a perspective view of the hand splint attached to a person&#39;s hand and arm; 
     FIG. 2 is a partial sectional view of the hand splint with parts broken away; 
     FIG. 3 is an expanded perspective view of the hand splint; 
     FIG. 4 is a bottom plan view of a foot splint; 
     FIG. 5 is a perspective view of the foot splint in use; and 
     FIG. 6 is a sectional view taken along line  6 — 6  in FIG.  5 . 
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     The muscle tone reduction splint  10 , as shown in FIGS. 1,  2  and  3 , is for reducing hypertonicity in the hand. The splint  10  has an elongated pad  12  or palm and finger cushion with an extremity contact surface  14 , an inside end  16 , an outside end  18 , a rear edge  20  and a front edge  22 . Three spaced apart elongated and flexible digit separators  24 ,  26  and  28  or abductor pads, are integral with the elongated pad  12  and extend forwardly from the front edge  22  of the elongated pad. The elongated pad  12  has an outer cover. The outer cover encases a resilient core material. At least the extremity contact surface  14  of the pad  12  and the portions of the outer cover of the flexible digit separators  24 ,  26  and  28 , that are in contact with the volar surface skin of a person using the splint  10 , are made from fabric that permits air to reach the skin of the person using the splint. 
     retainer strap  30  is secured to the elongated pad  12 . The strap  30  can be an elastic band with one end fixed to the inside end  16  of the elongated pad  12  and the other end fixed to the outside end  18  of the elongated pad. The strap  30  can also be made from a strip of soft webbing that is secured to the elongated pad  12  and has two free ends. A hook and loop fastener or other adjustable fastener can be used to secure the two free ends. 
     A dorsal stabilization lid or plate  32  with three slots  34 ,  36  and  38 , passes over the retainer strap  30 . The plate  32  is preferably a semi-rigid plastic material that can be fixed to the retainer strap  30  by stitching, an adhesive or by another suitable attaching system if desired. Bands  40  encircle each of the digit separators  24 ,  26  and  28 . Each band  40  is movable along the length of the digit separators  24 ,  26  and  28  to tighten the splint  10  as explained below. The dorsal stabilization lid  32  has a relieved area  41  over the metacarpophalangeal joints to promote comfort. The lid  32  an also be coated with a soft surface if desired. 
     A wrist splint  42  is a rigid or semi-rigid member. A forward end  44  of the wrist splint  42  is attached to the plate  32  by a hook and loop fastener or other suitable fastener system. As shown in FIGS. 2 and 3, the fastener system includes a loop pad  46  that is secured to the plate  32  and a hook pad  48  that is secured to a forward end  44  of the wrist splint  42 . An arm encircling strap  50  is secured to the rear end  52  of the wrist splint  42 . A fastener pad  54  of a hook and loop fastener on the free end of the arm encircling strap  50  engages and is held by a fastener pad  56  on a rear end  52  of the wrist splint  42  and the strap  50 . The pads  54  and  56  permit adjustment of the length of the arm encircling strap  50 . The pads  54  and  56  could be replaced by other fastener systems that permit adjustment of the effective length of the strap  50 . 
     The muscle tone reduction splint  10  is employed to decrease hypertonicity in the Lumbricale and Palmar interossei muscle groups, while providing stabilization of the metacarpophalangeal joint. The splint is attached to a hand  60  by inserting the fingers  62 ,  62   a ,  62   b ,  62   c  and  62   d  between the retainer strap  30  and the elongated pad  12 . The pad  12  is positioned against the metacarpophalangeals  64  of the hand  60  adjacent to the fingers  62 . The retainer strap  30  passes across the back  66  of the hand  60  adjacent to the metacarpophalangeals  64 . The separator  24  is pulled upward between the index finger  62   a  and the middle finger  62   b  and forced into the digit separator slot  34 . The flexible digit separator  26  is pulled upwardly between the middle finger  62   b  and the third finger  62   c  and forced into the digit separator slot  36 . 
     flexible digit separator  28  is pulled upwardly between the third finger  62   c  and the little finger  62   d  and forced into digit separator slot  38 . The bands  40  are forced onto, or permanently attached to, the flexible digit separators  24 ,  26  and  28 , and into contact with the top of the plate  32  to hold the elongated pad  12  against the metacarpophalangeal joints  64  of the hand  60 . In this position the digits or fingers  62  are separated and the fingers are held in an extended and abducted position. In the extended and abducted position, the first phalanx of each finger is nearly aligned with the attached metacarpal bone and the Lumbricale and Palmar interossei muscles are elongated. After the muscle tone of the wrist and hand is reduced, the wrist splint  42  is attached to the plate  32 . The arm encircling strap  50  is tightened around the arm  68  and the wrist is held in a more extended position. The inside end  16  of the elongated pad  12  flares between the thumb  70  and the first finger, maintaining the thumb web space. The flexible digit separators  24 ,  26  and  28  bands  40  hold the plate  32  in place. 
     The muscle tone reduction splint  10  reduces muscle tone throughout the upper extremity while providing stability at the metacarpophalangeal joint, the dorsum of the hand and the wrist. 
     The muscle tone reduction splint  72 , as shown in FIGS. 4,  5  and  6 , is for reducing hypertonicity in the toes, foot and ankle. Pressure applied to the metatarsal heads  75  at the metatarsophalangeals results in lower extremity extensor tone being reduced. The splint  72  has an elongated pad  76  with an inside end  78 , an outside end  80 , a rear edge  82 , and a front edge  84 . The front edge  84  of the pad  76  is a relatively large diameter and generally cylindrical pad portion  86  that is to be positioned in the toe crease under all of the toes of one foot. Four spaced apart elongated and flexible digit separators  88 ,  90 ,  92  and  94  are attached to the front edge  84  of the pad portion  86 . The elongated pad  76  and the flexible digit separators  88 ,  90 ,  92  and  94  have fabric covers that encases a resilient core material. This resilient core material in the pad portion  86  can be a resilient tube  96 . The core material in the digit separators  88 ,  90 ,  92  and  94  is preferably one that permits the passage of air to the skin of the foot  74 . 
     A retainer strap  98  is secured to the elongated pad  76  by stitches  100 . The ends  102  and  104  of the retainer strap  98  are overlapped but can be butted and secured in place by a hook and loop fastener  106 . The other half of the hook and loop fastener  106  is integral with the retainer strap  98 . Hook and loop fastener tabs  108 ,  110 ,  112  and  114  are secured to the free ends of the flexible digit separators  88 ,  90 ,  92  and  94 . The other half of the hook and loop fasteners is integral with the retainer strap  98 . 
     The muscle tone reduction splint  72  is employed to relieve pressure at the metatarsal heads and lessen tactile and proprioceptive input to the foot  74 , reducing tone in the ankle, foot and toes. The splint is attached to the foot  74  by positioning the large diameter rolled pad portion  86  in the toe crease  116 . The retainer strap  98  is then wrapped around the foot  74  as shown in FIG.  5  and secured in place by a hook and loop fastener. The flexible digit separator  88  is pulled up between the great toe  120  and the second toe  122  and secured to the retainer strap  98  by the tab  108 . Following the same procedure, the digit separator  90  is pulled up between the second toe  122  and the third toe  124  and secured in place by the tab  110  and the digit separator  92  is pulled up between the third toe  124  and the fourth toe  126  and secured by the tab  112 . Finally the digit separator  94  is pulled up between the fourth toe  126  and the little toe  128  and anchored to the retainer strap  98  by the tab  114 . 
     The muscle tone reduction splint  72  holds toes  120 ,  122 ,  124 ,  126  and  128  in an abducted position and provides stabilization at the metatarsal joint. This can result in decreased abnormal tone throughout the lower extremity. 
     disclosed embodiment is representative of a presently preferred form of the invention, but is intended to be illustrative rather than definitive thereof. The invention is defined in the claims.

Technology Category: 1