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Effectiveness of serial casting in patients with severe cerebral spasticity: a comparison study
Marcus Pohl1, Stefan Rückriem, Jan Mehrholz
1Department of Neurological Rehabilitation, Klinik Bavaria, Kreischa, Germany. pohl@klinik-bavaria.de
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 (chi(2)=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 (chi(2)=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.