In my last post, I wrote about the benefits and drawbacks of wearing splints and tried to give some suggestions for complying with a splinting regimen. I also thought that it might be helpful to talk about splinting for kids, and from a kid’s perspective.
Splinting is a major treatment modality for kids. While it offers some of the same benefits as for adults, like joint protection and improved function, splints also help prevent joint deformities and contractures (shortening) of the soft tissue around the joints, like muscles and ligaments. Contractures tend to occur when the muscles around a joint are maintained in a shortened, flexed position. With RA, this sometimes happens because inflammation makes it impossible to straighten a joint completely or because it sometimes feels better to favor the limb or digit by keeping it flexed. They can also occur because of unequal growth of bones making up the joint; a common problem for children with JIA as they grow. Splinting and stretching programs (both passive and active) are important for preventing contractures or to keep them from getting worse. Once contractures have formed, splinting, stretching and other modalities can be used to try to lengthen the soft tissue again, but if those methods fail, then surgery may be required.
I’ve had more splints, casts and orthotics in my lifetime than I can even count and I’ve had them for many of my joints – toes, ankles, knees, elbows, wrists, fingers. I’ve had working splints to wear all day for a finger and wrists as well as foot and ankle splints and orthotics. I still wear various wrist and foot devices periodically. And as a young child, I had a multitude of nighttime resting splints for my knees, elbows, hands and feet to keep me from resting my joints in a flexed position when I slept (because it was more comfortable than trying to straighten them). The morning stiffness was severe when I wore the splints, but worse if I didn’t. As a child, I often wore more than one night splint at a time. The most annoying were the elbow splints and the full ankle to thigh leg splint. I’m sure many readers can imagine the discomfort, having had similar experiences already.
I would like to note as well, that I’m sure that splinting protocols may have changed greatly in the last 20-25 years since I was a kid and the drug treatment has come so far that splinting as I knew it may not be as common now. Perhaps our rehab therapist members can comment on that.
So I’ve been thinking about my experience of wearing splints (day or night) as a child and remembering things that my parents did to make it easier. I offer them now as ideas or things to think about, to be added to the suggestions I gave recently for adults. First, splints can be uncomfortable, restrictive and sweaty. And especially for kids, a leg or arm splint may make it difficult for a child (or adult) to get in a comfortable position to sleep. My parents padded the splints as much as possible, made sure I always had a stockinette, long sleeve, or some soft material in between the plastic and my skin to reduce the sweating. And if I couldn’t get comfortable with extra pillows, I always had music playing to help distract me. Second, splints meant to straighten a contracture can become painful after a few hours. I would often take off my splints while asleep and find them across the room in the morning. And if a splint isn’t being consistently worn, it’s no good. So my parents listened to me, separating (and ignoring) my general complaints from the real concerns and they would take me back to my occupational therapist for modifications as necessary. In addition, my parents were very aware of my great need to fit in, or at least not stand out, especially in grade school. I hated being singled out by teachers at school or otherwise attracting attention because I was often teased and sometimes bullied. So sleepover parties were a welcome reprieve from the night splints. I also often chose the most boring skin colored splint materials I could find to try to attract less attention (even though I hated the neutral colors as being way too hospital-like). However, the color choices of the splint materials are 10 times cooler now than they were then, so kids (and adults) can express themselves; bedazzle them, autograph them, and rock out the bright colors- anything to make it more fun.
So kids and teens, what do you do to make your splints more a part of you and to make them more comfortable? Parents, what strategies have you found to ensure your child wears his splint regularly?