Effectiveness of serial casting in patients with severe cerebral spasticity: A comparison study

• Published in: Archives of physical medicine and rehabilitation Vol. 83; no. 6; pp. 784 - 790
• Main Authors: Pohl, Marcus, Rückriem, Stefan, Mehrholz, Jan, Ritschel, Claudia, Strik, Herwig, Pause, Max R.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-06-2002; Elsevier
• Subjects: Adult; Analysis of Variance; Biological and medical sciences; Brain Injuries - complications; Brain Injuries - rehabilitation; Casts, Surgical; Contracture; Contracture - etiology; Contracture - rehabilitation; Diseases of the osteoarticular system. Orthopedic treatment; Female; Humans; Joints; Male; Medical sciences; Muscle spasticity; Muscle Spasticity - etiology; Muscle Spasticity - rehabilitation; Neurologic disorders; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Range of Motion, Articular; Rehabilitation; Retrospective Studies; Statistics, Nonparametric; Rehabilitation; Casts, surgical; Neurologic disorders; Contracture; Muscle spasticity; Human; Nervous system diseases; Orthopedic treatment; Orthosis; Spasticity; Muscle tonus alteration; Replacement; Striated muscle disease; Biological effect; Neurological disorder; Muscular tonus
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1053/apmr.2002.32821

Pohl M, Rückreim S, Mehrholz J, Ritschel C, Strik H, Pause MR. Effectiveness of serial casting in patients with severe cerebral spasticity: a comparison study. Arch Phys Med Rehabil 2002;83:784-90. Objective: To compare the improvement and complication rate between a technique using a short casting interval and a more conventional changing interval. Design: A retrospective case-comparison study. Setting: A rehabilitation center for adults with neurologic disorders. Participants: One hundred five patients with cerebral spasticity of different etiologies treated with serial casting to relieve fixed contractures caused by increased muscle tone. Intervention: Serial casting of 172 joints (42 elbow, 41 wrist, 21 knee, 68 ankle joints), with cast-changing intervals of 5 to 7 days (group 1:92 joints, 56 patients), or 1 to 4 days (group 2:80 joints, 49 patients). Main Outcome Measures: Percentage of normal maximum range of motion (ROM) at the completion of casting and 1 month after discontinuation, and the number of complications resulting from casting procedure. Results: Improved percentage ROM immediately after serial casting and 1 month later in both groups (F=1469.5, P<.001). No differences in ROM improvement between groups were observed (F=0.3, P=.72). Complications in serial casting were found in 19.8% of 172 casting procedures, in 29.3% in group 1 and in 8.8% in group 2 (X2=10.2, P=.001). Discontinuations of treatment because of casting complications or other reasons were observed in 12.8% of the entire sample, in 18.5% in group 1 and in 6.3% in group 2 (X2=4.7 P=.03). Conclusion: Casting is effective in the treatment of fixed contractures of the upper and lower extremities caused by increased muscle tone of cerebral origin. Short changing intervals in serial casting provide improvements in ROM comparable with conventional changing intervals, and result in fewer complications. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation