The elbow wrist hand orthosis is comprised of the hand paddle originated by Waleed Al-Oboudi with its unique flat surface, shapes, and features. The hand paddle is attached to a forearm component and an upper arm humeral component which both help with increasing or maintaining wrist extension and elbow extension respectively. In addition, an optional attachment on the forearm component is available that aids in supporting the weight of the limb by attaching to the patient’s belt. Other options include interchangeable paddle hand splints with arches and/or individualized hand positions that aid in a graded therapeutic stretch among many other therapeutic benefits. Various types of straps are available to meet individual needs of the patients, however the straps featured are standard and provide for the most secure individual adjustments.
This orthotic is specifically designed to decrease the effects of hypertonicity in the finger, wrist and elbow flexors, while increasing passive range of motion toward finger extension, thumb extension, wrist extension and elbow extension. This orthotic is an important adjunct in the Neuro-IFRAH® Approach and the originator, Waleed Al-Oboudi, only recommends this adjunct versus ineffective imitations that are based on his concepts that are highly problematic.
There are three different types of wrist and elbow joints that are available for the Neuro-IFRAH® EWHO.
Option 1 – Ratchet Joint
The ratchet joint allows for movement in one direction at a time allowing for adjustment toward either extension or flexion in 5 degree increments. This joint is adjusted by a switch.
Option 2 – Step Lock Joint
When the step lock joint at the wrist is released, it allows for movement in both directions of flexion and extension, ranging from slight wrist flexion to 70-80 degrees of extension. When the step lock joint at the elbow is released, it allows for movement in both directions of flexion and extension, ranging from 55-180 degrees. This joint adjusts in larger increments that the ratchet joint, adjusting in 10-15 degree increments. This joint, though more expensive and slightly heavier in weight, is highly recommended by the originator of the Neuro-IFRAH® Approach because it allows for movement in both directions once the joint is released, and also limits the degree of movement from slight flexion/neutral to a maximum of 70-80 degrees of extension at the wrist and 180 degrees at the elbow. This allows the patient to keep the EWHO on while using their limb for support during transitional movements.
Option 3 – Adjustable Static Joint
This joint can be set at various degrees of flexion or extension. Once the joint is fastened, the position is maintained. The advantage of this joint lies in the maintaining the wrist at a specific position and preventing flexion or extension once the joint is fastened. This is ideal for conditions of observation where the therapist or family member adjusts the joint and intends to have the position maintained and not changed by outside pressure until the next adjustment is made. This joint is adjusted easily by unscrewing a knob and manually adjusting the angle. Unlike the other joint options, most of the time adjusting this joint requires the use of both hands, thus for braces that will be adjusted by the patient, option 1 or 2 are especially recommended.