Splinting in Burn Rehabilitation: Should Daytime Splint or Exercise Be the Priority? How to Balance Splinting in Burn Rehabilitation with Active Movement for Optimal Hand Function Recovery

Vita Yu-Hsien TU, Occupational Therapist and Project Manager

Sunshine Social Welfare Foundation

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Given its effectiveness, is wearing splints all day the best strategy? If a single rehabilitation method could deliver optimal results, it would undoubtedly be ideal—but rehabilitation is rarely that straightforward. Splints might feel like an easy solution since their use only requires proper application. Conversely, doing exercises requires active efforts which can be tiring and patients may even find it uncomfortable or painful. If given the choice, many might opt for splints over exercises. However, a balanced approach is necessary. For example, at night, when patients are at rest, wearing splints is the preferred intervention. During sleep, splints help maintain the hand in an optimal position, supporting the progress achieved through daytime rehabilitation while preventing a significant loss in joint mobility. Nighttime splints are an essential and efficient part of burn hand rehabilitation. But what about daytime rehabilitation? Should splints take priority over exercises?

Splinting and exercises have different purposes

Splinting in burn rehabilitation is a widely used therapeutic approach for managing hand burns. The purposes of splinting include:

• Immobilizing limbs to promote wound healing

• Protecting anatomical structures

• Restoring function and preventing deformities

• Restricting undesirable movements

• Correcting deformities

• Compensating for damaged or weakened muscles

But as discussed in our article on Maximizing Burn Recovery with AROM and Stretching: A Guide to Burn Therapeutic Exercises, the ultimate goal of burn rehabilitation is to restore a patient’s ability to perform smooth, functional movements and active exercises are crucial for achieving this. Exercises encourage the development of strength, coordination, and flexibility, which are essential for returning to daily activities. Splints alone cannot achieve this. Exercises also allow for functional integration. Daytime exercises often mimic or involve functional tasks, helping patients relearn and adapt movements necessary for daily living. For example, practicing grip strength or finger dexterity can translate directly to activities like eating, writing, or dressing.

Daytime Splint vs. Exercise: Key Considerations

When planning daytime rehabilitation, consider the following considerations to integrate splint use and exercises effectively:

1. Assess the Need for Immobilization

Identify if there is a need for immobilization, such as protecting wounds or delicate structures. If immobilization is required, wearing splints continuously is essential, and exercises should be postponed during this phase. For example, exercises are contraindicated during the wound healing phase in the case of dorsal hand burns, especially if the wound over the dorsum of the hand is deep or if the wound affects PIP joints with exposed tendons. On the other hand, if there are no exercise contraindications and the patient’s range of motion has not yet become restricted, it’s better to emphasize active range of motion exercises over the use of splints. Excessive immobilization can cause joint stiffness, contracture and soft tissue adhesion, therefore positioning and splinting must take place in conjunction with exercise plans.

2. Prioritize Adjacent Joint Issues

Evaluate all nearby joint concerns. For example, if the PIP joint needs immobilization for wound healing while the MP joint requires improved flexion, the PIP joint’s immobilization should take precedence. Understanding the hierarchy of priorities ensures that rehabilitation activities, including splint use, address each issue systematically.

3. Define Splint Purpose, Design, and Wear Schedule

Once issues and priorities are clarified, determine the purpose of the splint, the appropriate design, and the wear schedule. For instance, if the PIP joint requires immobilization, a finger gutter splint should be worn continuously. Rehabilitation activities to improve MP joint flexion can then be conducted while the finger gutter is in place. At night, the finger gutter splint should remain in use. Depending on the case, therapists may also consider adding a functional splint to support the MP joint’s positioning.

Splint Use and Exercises: Finding Balance

Splints are only one part of the rehabilitation process and should be integrated into the broader therapy plan. Active exercises, in particular, must not be neglected due to splint use. To resolve the dilemma of prioritizing splints or exercises during daytime rehabilitation, consider these factors: the need for immobilization, the priorities of adjacent joint issues, and the purpose, design, and timing of splint use. With this structured approach, you can clarify the roles of splints in both daytime and nighttime applications and resolve the question of which should take precedence during the day: splints or exercises.

Splinting in Burn Rehabilitation: Case Study of Small Finger Rehabilitation

A patient presented with good MP flexion/extension angles in the little finger but limited PIP extension and ulnar deviation caused by scar tension extending from the volar and ulnar aspects of the finger to the palm. Addressing these issues required limiting MP joint movement to maintain PIP extension and reduce ulnar deviation. However, restricting MP joint movement could impact hand function.

To manage this, the therapist adopted the following strategy:

• Nighttime: The patient wore a larger splint to position the PIP joint in extension and reduce ulnar deviation.

• Daytime: A smaller finger gutter splint was used to maintain PIP extension while allowing functional MP joint mobility for daily activities.

This approach addressed the primary issue (limited PIP extension) both day and night. The secondary issue (ulnar deviation) was tackled at night, while daytime activities prioritized mobility. This balanced strategy ensured effective rehabilitation without compromising the patient’s daily functionality.

A finger gutter is used during the day.

During the day, the finger gutter is also used when the patient carries out daily activities and functional training.

Another splint is worn when sleeping. On the little finger, the splint positions the PIP joint and prevents MP joint ulnar deviation. The other splint positions the thumb and maintains the first webspace.

Conclusion

Splinting is an integral part of burn rehabilitation, but it should align with overall therapy goals and be combined with active exercises. The key lies in balancing splint use and active movement to support functional recovery.

When planning rehabilitation:

1. Assess the need for immobilization.

2. Prioritize issues affecting adjacent joints.

3. Define the splint’s purpose, design, and wear schedule.