Frequently with neuro-paediatric elbow contractures clients often require a made to measure custom gaiter when a joint cannot be passively fully extended. Adult neuro clients also have the same requirement; although a larger selection of off-the-shelf braces are available, but not all are easily adjusted / fit well.
Recently the Artisan Elbow Immobiliser was trialled for these two groups with mild to moderate hypertonia, and found to yield excellent results from an OTS solution, whilst giving a custom fit.
It is sized from a small paed size to adult from a single measurement. The unique aluminium reinforcement is easily shaped and lightweight for an intimate fit to accommodate any limb shape. It has been especially useful in that it can be reshaped to any ROM changes without tools, and then locked into place with the velcro L tabs; purely by hand. Other OTS devices are sometimes confusing and tricky with dual hinges to set ROM, time consuming due to fiddly parts at the bedside, and for mild to moderate hypertonia paed clients a little over engineered for the task.
We find that if we need to be very specific with setting our angles due to the absence of a ROM joint to indicate; then using a simple goniometer to measure the final set up was all that was required. Other braces however well they indicate an angle on the hinge, rarely mimic the true position of the clients as they often do not align with the anatomical position very well.
In cases with commonly seen increased forearm pronation we found the long forearm trough especially useful with its high sides shaped well to give some rotational resistance, this is further helped by the reinforced palmar strap, and the ability to have the trough extend into the palm and shaped to almost a wrist hand orthoses whilst allowing prominent styloid to be accommodated by shaping relief. If we did not feel extending to wrist was required we simply either fitted a smaller size, or folded back the pliable aluminium.
The immobiliser is plush lined, and the aluminium internal structure is perforated to allow for moisture wicking. The edges have no aluminium so affords a soft edge in the axilla area, and in cases of unusually short humerus the top can be rolled over to reduce the height. It is supplied with a selection of lay on straps with no pre-determined locations; allowing the clinician to place for best alignment.
Clients and staff to date have found it highly comfortable, and in some cases superior in being able to reliably don correctly due to its simplicity. We are extremely happy we can give a custom fit gaiter solution from a single measure without the burden of waiting for an MTM item to arrive.
There are many other pathologies in which the elbow may need to be immobilised at a pre determined angle, for example cubital tunnel syndrome, fractures, or soft tissue injury. As you can see the Artisan Elbow immobiliser has a much wider reach for the clinician.