Splints, Braces and Self Care
Standard fracture care often requires immobilization of a body part with use of braces, splints, slings, wraps and more. Immobilization is often accompanied by a medical order for non weight bearing which means “do not use the affected body part at all”. Immobilization and non weight bearing promote healing of a broken bone. These restrictions cause difficulty with performing self care in addition to the pain that goes along with the fracture.
Neck Braces:
In the case of a neck fracture the patient usually leaves the hospital wearing a neck brace. Hard neck braces are the treatment for neck fractures that are not surgically repaired. Soft neck collars are generally reserved for lesser injuries, like whiplash. A hard neck collar causes numerous problems with eating, drinking, bathing, dressing and walking, to name a few.
If a neck brace/collar is prescribed, it’s a good idea to get a second one from the provider, since the original will definitely become soiled. Never remove the collar without explicit instructions from a trained caregiver. After all it was prescribed to heal a serious fracture that might be unstable.
Activities of Daily Living (ADLs) With a Neck or Back Brace
Because the neck brace or collar is designed to restrict head movement the user cannot bend forward to eat. Arm movement for eating while wearing a neck collar requires mostly shoulder motion. Because the collar fits snugly under the chin there’s bound to be food spillage. A napkin tucked under the chin helps a bit. Drinking liquids is also a challenge. Straws make the task of drinking much easier. Have plenty of straws on hand.
Dressing
Getting dressed with a neck collar is hard because pullover shirts may have a narrow neck opening.
Look in the closet for large, loose, stretchy V-neck shirts or button front shirts. Likewise, pants and underwear can be challenging. Choose items that have no fasteners, are loose, stretchy and comfortable.
Getting dressed in front of a full length mirror will help you see what you are doing while wearing a neck collar. Ladies, do you really need to wear a bra? Instead of a bra I recommend use of a camisole or tank top for modesty, and another loose shirt over that.
Footwear
It’s hard to see anything below eye level or on the floor since looking down is restricted by the neck or back brace. Leave your shoes on top of a dresser, rather than on the floor, so you can more easily find them.
Slip on shoes are easier to manage than shoes with laces. Shoes with laces can be converted to slip ons by loosely pre-tying the laces, thus avoiding bending and tying. You may find that using a reacher, dressing stick and long handled shoe horn helps to overcome some of your dressing challenges. See examples of long handled equipment in the Products page of this website.
Moving Around
While walking, watch your step, plan your route, be cautious of pets and toys or items that may have been left on the floor. Always prioritize use of comfortable, quality footwear. When walking, stop before changing direction or making a turn since you cannot visually turn your head to scan for obstacles, pets, etc that could cause a fall.
Do not go on stairs unassisted.
Do not leave the house unaccompanied with a neck brace on.
Do not drive with a neck brace on!
Bathing
For bathing you use your second collar as a shower collar/wet collar. Or tuck a layer of thin plastic all around the collar to keep it dry while showering.
Sit on a tub seat and use a hand held shower to be as safe and independent as possible in the wet area. Be sure someone is there to offer a hand in the wet area.
Remember you cannot safely or easily bend, lift, twist or even see with a neck collar in place. You need a second set of eyes.
Grooming
Shampooing is especially tricky with a neck or back collar in place. Going to a hairdresser and leaning back for a shampoo may be out of the question. Use a dry shampoo product or a shampoo cap, shown on the Products/Shop page of this website. The cap comes pre-loaded with shampoo and liquid. It can be warmed up in a microwave oven before use. Place it on the head, rub it around for a few minutes and voila!….clean and sweet smelling hair. The shampoo cap is especially useful for someone who is bed bound.
Don’t expect to clean the back of head where the neck collar rises up high, and hair may have been shaved or there is a surgical incision.
Brushing Teeth
For brushing teeth, everything is relatively normal if you are standing in front of a sink. Normal that is until it comes time to rinse your mouth and spit. At that point you should have a cup of water and a hospital style kidney basin to hold closely under your chin, but above the collar, to spit into. No doubt the collar will get dirty during toothbrushing. An electric toothbrush is recommended.Don’t forget to floss. Floss sticks allow one handed use, leaving the other hand to stabilize while standing.
Bathroom Use
If the neck brace is being used because of a fall and fracture then all precautions must be taken about toilet, tub and shower use. See previous blog posts for detailed information about bathroom safety. In the bathroom there are likely to be wet areas or water spills and hard, unyielding fixtures.
Reaching behind for bum wiping can be challenging as can reaching down to pull pants up or down. See previous posts that address those specific areas.
Remember you cannot safely or easily bend, twist, lift or even see with a neck collar in place. Consider the bidet as a viable alternative for hygiene. See an example of a bidet on the Products/Shop page of this website.
Shoulder/Elbow/Wrist/Hand Fracture Braces and Splints
A shoulder, elbow, humerus, wrist, finger or hand fracture with a splint, sling or brace presents a severe limitation for anybody. Typically the patient will be non-weight bearing in the initial weeks post fracture, meaning you must avoid using the injured body part, allowing it to heal. That leaves the person unable to use the affected body part at all so they are sddenly one handed.
For someone that is one handed it is a blessing if it’s the dominant hand that is spared. When the dominant hand is broken it is a harder adjustment to one handedness.
It’s a difficult transition to suddenly become one handed and non weight bearing, especially if the patient has pain and cognitive deficits. That’s a lot of new learning!
There are adaptive methods and equipment to stabilize objects for one handed use. Try a Google or YouTube search for a specific activity to see if there are recommended one handed techniques.
Leg Fractures and Braces
When a hip, femur, knee, tibia/fibula, toe or ankle fracture occurs a brace is often provided by a hospital caregiver. The brace is used to stabilize the fracture in a set position to promote proper alignment and healing. The brace will have been fitted to the patient. It will likely have large sections of straps, velcro, buckles, clips, pads and maybe even hinges. It might be all black or all white. Chances are there will also be weight bearing restrictions prescribed.
Putting a Leg Brace on At Home
In my experience patients and caregivers often have trouble managing a brace at home.
Braces get put on upside down and backwards. It’s often seen as a puzzle with guesswork used to re apply it. The results are often a danger to the patient if the brace is placed incorrectly, too loose or too tight, upside down or backwards. With any type of leg brace, expect that gravity will effect it the same way that it affects all things~the brace will slide down and need to be repositioned frequently. Take a photo of the brace, properly applied, for future reference.
Marking Up a Leg Brace
Families and patients benefit from markings on a brace so that it goes on properly every time. I have used markings to show top/bottom, front/back, up/down and left/right.
Wite-Out correction fluid is useful for marking all-black braces. Colored tape and nail polish highlight landmarks on any brace. Colored tape can cover the end of a Velcro strap to create a pull tab and visual marker.
If the brace doesn’t fit well ask for help with it from a trained professional. Usually when someone has a fresh fracture they are non weight bearing. Do a Google search to learn more about weight bearing restrictions.
Dressing with a Leg Brace
The question frequently arises “Does the leg brace go on over or under pants?”The answer is “That depends…”. It depends on the type of clothing available to the wearer. Do those pants fit over the brace or does there need to be a slit made in the seam of the pants to accommodate the brace? Is there a pair of snug fitting, thin yoga pants that fit under the brace and serve to protect the brace from rubbing against fragile skin? Is there a wound with a bulky dressing? If so does that mean the brace needs to be removed for dressing changes? These legitimate and important questions should be posed to the healthcare professional who initially provides the brace.
Finally, as a general rule skin needs to be protected from the rubbing and shifting motion of a brace. Use thin clothing, ace wrap or other protection to protect the skin from the brace.Ask your health care provider for help to determine what’s right in your situation.
