CLIKStrips

Vazquez Inelastic Mobilization System

Frequently asked Questions

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What is static-progressive splinting?

Static progressive splinting is the terminology commonly used to describe the technique of mobilization splinting with inelastic traction.  It is an effective alternative to dynamic (elastic) traction for lengthening soft tissue with limited pliability and for increasing PROM of contracted joints. 

By splinting and maintaining the tissue at the available end-range-under low-load stress, the structures have time to grow new cells, and a new end-range is established. After the tissues lengthen, the inelastic mobilization component is adjusted in small increments to maintain low-load prolonged stress at the newly established end-range.

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How does mobilization splinting with inelastic traction work?

When prolonged, low-load stress is applied, the tissues gradually lengthen to accommodate the applied tension.  This is why tissue expanders work, and it is also why inelastic traction works to increase PROM!
 
It is important that the right amount of tension be applied to the splinted tissue. Too much tension can tear or damage the tissue. Tension that is of too low magnitude will not result in tissue lengthening.
 
Clinical research demonstrates that low load prolonged stress to PROM limitations results in permanent tissue lengthening and increased ROM.
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It is important to understand the stages of wound healing when determining the most appropriate method of treatment.  Inelastic (static-progressive) traction can be applied to any soft tissue that can safely tolerate elastic (dynamic) traction.  Generally, inelastic traction is not used with acute joint injuries.  It is more appropriate to use inelastic traction with injuries where the inflammatory stage of healing has run its course.
 
For the past 7 years the creator of ClikStrips™ has used various methods of inelastic traction for mobilization splinting.  Clinically, he has found inelastic traction so effective that he seldom uses dynamic traction to mobilize PROM limitations.
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Inelastic traction is a long established method for remodeling stiff joints and increasing joint range of motion.  It can be applied to rest and hold healing tissue at end-range as early as the start of the proliferative phase of healing.  This may actually be safer than elastic traction which consistently applies tension to tissue that is attempting to heal.

Inelastic traction can be used prior to the late maturation phase of healing, as not to pass up chances to provide tissue growth.  "Biological windows of opportunity come and go as time progresses.  If windows are missed, they cannot be regained easily, since the inevitable sequelae of ever-increasing joint stiffness and tethered soft-tissue glide become more and more devastating with the passage of time" FESS
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Dynamic splinting allows for function and exercise, while promoting edema reduction and cartilage nourishment. When elastic mobilization splinting is used to increase PROM limitations, the splinted tissues continue to be stressed even when they have reached their end-range. This may result in tissue damage.

It can also be difficult to maintain consistent tension on the dynamic splint, due to hysteresis and creep of the elastic traction sources (rubber bands, springs, etc).

Mobilization splinting with inelastic traction maintains a low-load stress at end range--without stressing beyond that point. This technique results in tissue lengthening without tissue damage.

There are times when it is beneficial to use both techniques on the same splint--alternating between inelastic traction to elongate the tissues, and elastic traction to allow motion within the confines of the splint.  For an example of this type of splint, click here.
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For what length of time should inelastic traction be applied?

Specific guidelines have not been developed. Various factors influence the length of time the splint should be worn--including type and extent of injury, duration of PROM limitation, the patient’s physiological response to the injury, the time from injury and the duration of the PROM limitation.

If you have never used inelastic traction, you can start by using the length of time guidelines that you currently utilize with elastic (dynamic) splinting.

When inelastic traction is properly set, it is generally tolerated for longer wearing time than dynamic splints.

A study by Ken Flowers and Paul LaStayo on Total End Range Time (TERT) concluded that "...the increase in PROM of a stiff joint is directly proportional to the length of time the joint is held at its end range."FLOWERS
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Paul Brand, MD wrote "I do not know how much tension is needed to stimulate growth, but from experience I judge that when the skin is held gently and continuously on-the-stretch to the point of early blanching, it is stimulated to lengthen....growth is a matter of days and the stimulus needs to be continuous for hours at a time..."BRAND

Learning to apply the correct amount of tension comes with experience in assessing joint/tissue end feel.

It is important to closely monitor the response of the patient’s tissue both at the traction site and the area where the tissue is experiencing stretch (i.e. stretching a skin graft).  The goal of inelastic traction is for the applied force to be equal to the resistance of the contracted tissue.  Inelastic traction is an isometric force that should match the restriction, but not exceed it.
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How do you know when to increase the amount of tension applied to the splinted joint?

As the restricted tissues rest at end-range, cell proliferation and fiber re-arrangement occur; tissue lengthening results. As the joint relaxes into its new length, the inelastic mobilization device is advanced in minimal increments.
 
Inelastic traction must be adjusted incrementally to accommodate gains in PROM. It must always provide low load stress at end-range--not beyond it. It is important to remember that static-progression is not a force against the restricted tissue, but a force to equal the restricted tissue.
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Can patients adjust the tension of the inelastic mobilization device by themselves?

“It is very important that the patient understand the concept of incremental increases to prevent damage to tissues. The inherent feedback from each advancing visible ridge [on the ClikStrips™], at times “over motivates” the patient to advance the Strip prior to the tissue’s ability to tolerate the tension. For this reason it is best that the therapist perform the advancements, at least initially.”   (Vazquez)

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Therapist’s have often complained that the cost of commercially available static-progressive splints or splinting components puts them out of the reach of many patients. Therapists have tried many approaches to overcoming this problem including trying to “recycle” the splint component from one patient to the next.
 
In response to this budgetary concern of therapists, WFR Corporation has teamed with Nelson Vazquez OTR/L CHT to develop ClikStrips™…the most cost-effective, easiest way to make static-progressive splints.
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bullet ClikStrips™ are the only inelastic traction (static-progressive) splint components to incorporate distinct, measurable incremental adjustments--so you can monitor and document progress.
 
bullet The unique, very low-profile, streamlined design minimizes bulk and makes it practical to use a single unit or multiple ClikStrips™ on one splint. This is especially important on hand-based splints where there is not much room to mount splint components. Other component systems may be too bulky and cumbersome for using multiple units on one splint.
 
bullet ClikStrips™ are priced right! Now inelastic mobilization splints can be affordable for all of your patients with PROM limitations…let them benefit from the advantages of inelastic mobilization with inelastic traction.
 
bullet Audible click and visible progress marks provide constant feedback to patient.
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For information on attending or hosting a static-progressive/inelastic mobilization  splinting workshop, please e-mail Damon@Reveals.com or call WFR Corporation at 201-891-1042 or 1-800-526-5247.
 
Information about Reveals™ Low Temperature splinting materials manufactured by WFR Corporation can be found at www.Reveals.com.
 
Technical questions regarding the use of ClikStrips™ can be e-mailed to Nelson Vazquez OTR/L, CHT at Vazhand@ClikStrips.com.
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Last modified: 06/01/03.