Choosing an appropriate thermoplastic material is one of the most important aspects of orthotic fabrication. It’s the first step to take, after you have evaluated your patient.
The wide variety of thermoplastic materials gives you all the options to perfectly customize the orthosis to your patient’s needs. If you understand the properties and possibilities of each material, you will always be able to make an informed decision.
Here are 6 points to consider when making decisions about the specific thermoplastic material to use for any given orthosis:
In the hot summer months, perforated materials should be your go-to choice. Patients will have a hard time wearing a purely solid thermoplastic orthosis on their injured arm without any ventilation or air getting through to the skin.
Perforated materials do require some advanced cutting skills, and extra work smoothing out the rough edges. Make sure to stretch the material evenly so all of the perforations remain equal in size.
Patients will appreciate a cotton stockinette sleeve worn underneath the orthosis to absorb perspiration.
Consider the purpose of the orthosis and the specific placement on the extremity:
Non-stick (NS) coated materials will not bond accidentally to themselves (or the towel) and are generally easier to work with than non-coated materials. NS coated materials can be pinched together to form circumferential orthoses and then popped open when the material has cooled. This technique is much more difficult with non-coated materials.
Choose non-coated materials when you need to attach outriggers or bond layers together firmly. Keep in mind that the coating can also be scraped off on NS coated materials. When the material is then heated with dry heat, you can form permanent bonds.
All materials with NS in their product name have a non-stick antibacterial coating, like Orfit Colors NS, Aquafit NS, Orfizip Light NS, etc.
Remember that memory is the material’s ability to return to its former size after activation in hot water, moulding with stretch and cooling. All thermoplastic materials will revert to a flattened state when put back into hot water.
Products with memory will shrink back to the starting shape and size. This allows the therapist to remake an orthosis if there was a problem with the original positioning or if the patient now has less oedema than before and the orthosis needs to be reformed and remoulded.
Choose a product with memory, such as Orfit Classic and Orfit NS, if this is an important consideration.
You might want to consider the additional weight burden the orthosis will place on the patient’s injured extremity. If possible, choose the material that meets all of the above criteria but has the lightest weight possible.
Heavy materials might be required for patients with high tone or larger limbs. But smaller frame adults, the elderly, and paediatric patients will all benefit from lighter orthoses. Those can be made from lighter materials such as Orfilight and Orfilight NS products as well as Orficast and Orficast More.
These 6 points will help you in the decision making process. Think of these when the next orthosis must be fabricated for a new patient. Over time, these concepts will become second nature and you will gravitate towards the best and most appropriate material for any given orthosis.
Written by Debby Schwartz, OTD, OTR/L, CHT
Physical Rehabilitation Product and Educational Specialist at Orfit Industries America.
Debby is a certified hand therapist with over 36 years of clinical experience. She completed her Doctorate of Occupational Therapy at Rocky Mountain University of Health Professions in 2010. She has worked at Orfit Industries America as Product and Educational Specialist since 2007.
Debby is also an adjunct professor at the Occupational Therapy Department of Touro College in NYC and has written many book chapters in the field of hand therapy and multiple articles for hand therapy journals, including the ASHT Times and the Journal of Hand Therapy. She has published a new textbook on orthotic fabrication together with Dr. Katherine Schofield, entitled “Orthotic Design and Fabrication for the Upper Extremity: A Practical Guide”.