A COTA treats a client with a proximal interphalangeal (PIP) flexion contracture to improve extension. Which option uses limited therapy time most effectively?

• A. Apply paraffin followed by joint mobilization techniques
• B. Fit the client with a prefabricated dynamic PIP extension assist splint
• C. Instruct the client in flexion blocking exercises
• D. Fabricate a customized dynamic PIP extension assist splint

Answer: (B)

Utilizing a device that provides ongoing, patient-driven extension requires the least direct therapist time while still promoting progress. A prefabricated dynamic PIP extension assist splint acts as a ready-made, off-the-shelf support that the patient can wear during daily activities. It delivers a gentle, continuous extension force to the proximal interphalangeal joint, helping to lengthen the flexor tendons and gradually improve range without needing lengthy in-clinic sessions or custom fabrication. This means meaningful gains can occur between visits, making the most of limited therapy time.

In contrast, a customized dynamic splint, while effective, requires time to fabricate and adjust, which uses more of the initial therapy time. Paraffin and joint mobilizations are valuable modalities but demand direct hands-on time during each session and don’t provide the same sustained, at-home extension stimulus. Flexion-blocking exercises can aid progression but still rely heavily on clinician supervision and may not optimize time efficiency to the same extent as a readily available extensor assist worn by the patient.