Advice from a Certified Hand Therapist: Types of Custom Orthoses

In the blog entitled “What is a Custom Orthosis?” basic information on custom orthoses was provided. But as hand therapists we can do so much more! In this blog, different types of custom orthoses and the reason your doctor and therapist may recommend one or another will be reviewed. In general, an orthosis is a device that is molded to and worn on a specific body part. The device can help to protect and support bones, tendons, ligaments, and nerves, and keep these structures in safe and healthy positions. An orthosis can also be used to help fix deformities or help people with limitations function better. Orthoses can be used to immobilize (keep the body part and tissue still), to mobilize (move the area) or to restrict partial movement in an area.

Some of the reasons your doctor might prescribe a custom orthosis include:

• Arthritis
• Tendon injuries
• Broken bones
• Pain
• Burns
• Nerve injuries
• Stiffness
• Weakness

Each individual orthosis has a specific purpose. The different types of orthoses that will be reviewed are static, static progressive, dynamic (for increasing motion) and dynamic (for function). 

Static Orthosis  

The purpose of a static orthosis is to stabilize, support and protect. A static orthosis is used to immobilize or restrict motion at a joint. It is stiff and holds a given body part in a safe position.  This type of orthosis does not apply any over-pressure or stretch to the body part(s) it covers.

Static Progressive

The purpose of a static progressive orthosis is to gradually increase motion. This type of orthosis provides consistent pressure or stretch at the furthest point the joint can move. When the tissues (joint, muscles, tendons, ligaments) have adjusted to the position and a stretch is no longer felt, modifications are made to the orthosis to increase the position and stretch. This occurs as many times as needed until the range of motion goals are achieved.  

Dynamic Orthosis (for increasing motion)

The purpose of a dynamic orthosis for increasing motion is to provide stretch. A dynamic orthosis provides continuous stretch to a stiff body part in one direction and allows the body part to move in the opposite direction. Often times, rubber bands are used to provide the stretch.

Dynamic Orthosis (for function)

The purpose of a dynamic orthosis for function is to support body parts through motions that may be lost due to injury, surgery or various conditions.

Hand therapists are specially trained in making static, dynamic and static progressive custom orthoses. He or she will work carefully to provide a perfect fit and stretch as needed. The use of wires, rubber bands, Velcro, and other materials to create different types of orthoses requires the hand therapist to pay special attention to angles and direction of pull. Your orthosis and progress will be monitored closely throughout your treatment, and adjustments to the orthosis and any of its parts will be made as needed. 

Your doctor or therapist will review what, if any, activity is appropriate while wearing your orthoses. They will clearly communicate your individual orthosis and treatment plan with you and will keep you informed as things change throughout your care. Some orthoses are made to be worn for a short duration while others are meant to be worn for a  longer term. As discussed in the blog entitled “What is a Custom Orthosis?” it is important to follow the instructions from your doctor and therapist so that you can make steady progress toward your goals.  

If you would like to find a hand therapist near you, please visit ASHT.org.

Courtney Middleton, OTD, OTR/L, CHT, CLT is a certified hand therapist and a member of the American Society of Hand Therapists (ASHT).