CMAJ • June 17, 2008; 178 (13). doi:10.1503/cmaj.1080045.
© 2008 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters

Splinting in the intensive care unit

Heather L. Mac Neill, MD BSc(PT)

Department of Physical Medicine and Rehabilitation, Bridgepoint Hospital, Toronto, Ont.

Heidi Clavet and colleagues recently reported the results of a study in a much-needed area of research that receives little attention.1,2 Conservative treatment of contractures is time consuming and often results in few gains in cases of significant contracture.3 The wait time for a procedure to lengthen the Achilles tendon at a Toronto tertiary care centre is about 2 years. As mentioned by Clavet and colleagues, intensive care units do not have enough physiotherapists, occupational therapists and nurses to provide sufficient passive range of motion exercises to prevent the onset of contractures.

The most frequent and functionally limiting contractures I see are ankle plantar flexion contractures (which limit independent transfers and ambulation) and contractures of the intrinsic muscles of the hand (which limit eating, dressing and writing). Given the lack of resources, it may be prudent to consider recommending the use of over-the-counter ankle–foot orthoses to promote ankle dorsiflexion and gloves or splints to stretch the intrinsic hand muscles for all patients admitted to the intensive care unit for longer than 2 weeks. These devices are easily applied and do not interfere with lifesaving devices; however, the patients need to be monitored for skin breakdown. As well, teaching the family to do range of motion exercises for the hands and ankles (which again would not interfere with lifesaving devices) could be beneficial to patients, the health care team and family members, who desperately want to feel they are helping their loved ones.

Footnotes

Competing interests: None declared.


REFERENCES

  1. Clavet H, Hebert PC, Fergusson D, et al. Joint contracture following prolonged stay in the intensive care unit. CMAJ 2008;178:691-697[Abstract/Free Full Text]
  2. Fergusson D, Hutton B, Drodge A. The epidemiology of major joint contractures: a systematic review of the literature. Clin Orthop Relat Res 2007;456: 22-9.[CrossRef][Medline]
  3. Farmer SE, James M. Contractures in orthopaedic and neurological conditions: a review of causes and treatment. Disabil Rehabil 2001;23:549-58.[CrossRef][Medline]




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