Teddy Bear Splint: Modifications to a Comforting Toy Can Achieve Orthotic Goals of a Volar Resting Splint

Jordan Raugust, MD Stacey Brown, BPHE, CO(c) Sarah Lendrum Dip P&O, CO(c) Tamara Thicke, MSC OT John Latter, MD, MPA, FRCPC


Setting

Inpatient pediatric hospital.

Patient

A 9-year-old female following a severe anoxic brain injury due to cardiac arrest, with dystonic upper limb flexion-supination posturing and paroxysmal exacerbations of this dystonic posturing associated with agitation.

Case Description

On our assessment at one month post injury, the patient demonstrated persistent bilateral upper limb flexion-supination posturing, while maintaining passive ROM. As she became more alert, she began to have episodes of agitation, during which her dystonic posturing became more severe. During these paroxysms, her postured fists bruised her chest and appeared to distress the patient. In order to maintain functional positioning while active movement was limited, we applied volar resting splints. Unfortunately, the patient did not tolerate them, as she became more agitated when they were applied and demonstrated evidence of skin breakdown after a few hours of wear. We noticed that the patient often held a teddy bear in each hand while resting in her postured position, which appeared to give her comfort. The possibility of using a teddy bear to achieve orthotic goals was raised.

Orthotic Goals

Our orthotic goals were as follows:

  1. Passive positioning with slight finger flexion and wrist extension at rest
  2. Protection of chest from pressure exerted by fists during dystonic paroxysms
  3. Limiting skin breakdown due to straps or splint pressure during dystonic paroxysms fort to the patient with the goal of attenuating dystonic paroxysms
  4. Provision of emotional comfort to the patient with the goal of attenuating dystonic paroxysms

Because the conventional resting splint was not tolerated, it failed to achieve these orthotic goals. The patient's unmodified teddy bear better satisfied these criteria, and we attempted to enhance its performance as an orthotic device, while preserving the physical and emotional comfort it provided.

Intervention

Modifications were made to a teddy bear to further enhance its ability to meet the orthotic goals. The nose of the bear was used to passively position the patient's hand and wrist in slight extension. It was secured in position with a soft strap running from the first webspace, across the dorsum of the hand. The forearm was secured in position by the teddy bear's arms, which were held together with velcro away from the patient's skin. The stuffing was removed and replaced with a foam insert that had a forearm trough angled to direct the patient's hand on the far side of the bear's nose. This trough provided structural resistance to wrist flexion, while allowing the nose and head to protect her chest from her fist during the dystonic posturing. Finally, the teddy bear's leg closest to the patient's body was placed in the antecubital fossa, providing mild resistance to terminal elbow flexion that occurred during posturing.

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Outcome

The use of the modified teddy bear enhanced the ability to meet our orthotic goals. The patient tolerated the orthosis well, with no skin breakdown, and seemed to be comforted by it's application. Between dystonic paroxysms, the bear passively positioned the wrist and hand near our desired position. During dystonic episodes it provided minimal resistance to posturing, but protected her chest from contact with her fist.

Conclusions

This case demonstrates how modifications to a teddy bear can achieve the orthotic goals of a volar resting splint while continuing to provide comfort to a pediatric patient who is agitated following a brain injury.

Department of Clinical Neurosciences, Division of Physical Medicine and Rehabilitation, University of Calgary

Neurosciences, Othotics, Alberta Children's Hospital

Neurosciences, Othotics, Alberta Children's Hospital

Neurosciences, Occupational Therapy, Alberta Children's Hospital

Department of Clinical 1eurosciences, Division of Physical Medicine and Rehabilitation, University of Calgary