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The effects of serial casting on lower limb function for children with Cerebral Palsy: a systematic review with
Nikki Milne1,2, Michelle Miao3, Emma Beattie3
1Physiotherapy Program, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, 4229, Australia. nmilne@bond.edu.au.
Insights
Serial casting for children with Cerebral Palsy (CP) effectively improves ankle range of motion and reduces hypertonicity. While it enhances gait, its impact on gross motor function requires further investigation.
Area of Science:
- Paediatric rehabilitation
- Neurology
- Orthopaedics
Background:
- Lower limb serial casting is a common therapeutic intervention for children with Cerebral Palsy (CP).
- Existing evidence supports the efficacy of serial casting in paediatric clinical practice.
- This review focuses on the effects of serial casting, alone or combined with other therapies, for lower limb dysfunction in children with CP.
Purpose of the Study:
- To systematically review the effects of serial casting on lower limb dysfunction in children with Cerebral Palsy (CP).
- To evaluate serial casting's impact on functional outcomes, including range of motion, spasticity, gait, and gross motor function.
- To synthesize evidence from existing literature to inform clinical practice.
Main Methods:
- A systematic literature search was conducted across eight databases in February 2019.
- Key terms included 'Cerebral Palsy' and 'serial casting' and their synonyms.
- Meta-synthesis and meta-analysis were performed on data concerning functional outcomes.
Main Results:
- Twenty-five studies were included in the review.
- Serial casting improved passive ankle dorsiflexion range of motion (PROM) and decreased hypertonicity in the short-term.
- Serial casting enhanced functional gait in the mid-term but did not significantly affect gross motor function (GMFM).
- Combined serial casting and pharmacological intervention showed greater PROM improvement than casting alone, though clinical significance is uncertain.
Conclusions:
- Lower limb serial casting is beneficial for improving ankle PROM, reducing hypertonicity, and enhancing gait in children with CP.
- Further research with robust designs is needed to clarify long-term effects on gross motor function.
- Findings support the use of serial casting in individualized treatment plans for children with CP.
Background:
Lower limb serial casting is commonly used therapeutically in paediatric clinical practice with some evidence to support its efficacy. This systematic review aimed to determine the effects of serial casting in isolation or combination with other therapies for the management of lower limb dysfunction in children with Cerebral Palsy (CP).
Methods:
A systematic literature search was conducted in February 2019 across eight databases (PUBMED, EMBASE, CINAHL, PEDro, OTSeeker, Cochrane, Scopus and Proquest) using key terms 'Cerebral Palsy' and 'serial casting' and associated synonyms. A meta-synthesis and meta-analysis were undertaken when sufficient results were available showing the effect of serial casting on functional outcomes including: Ankle range of motion; neurological measures of hypertonicity and spasticity, functional gait measures and; gross motor function.
Results:
Twenty-five articles from 3219 possible citations were included. Serial casting was found to be effective for: Improving ankle dorsiflexion (DF) passive range of motion (PROM) in the immediate to short-term, decreasing hypertonicity measured by Modified Ashworth Scale (MAS) in the short-term and, enhancing functional gait outcomes in the mid-term. Serial casting with or without botulinum toxin type-A (BTX-A) did not significantly affect gross motor capacity measured by Gross Motor Function Measure (GMFM). Serial casting with pharmacological intervention achieved significantly more DF PROM than serial casting alone (MD - 3.19 degrees; 95% CI - 5.76 to - 0.62; P = 0.01; I2 = 0%), however the clinical importance of improving ankle DF PROM by an additional three degrees remains unclear.
Conclusions:
Lower limb serial casting, improves several outcomes relevant to lower limb function supporting its clinical use for improving DF PROM, reducing hypertonicity and improving gait in children with CP. Further research using stronger methodological study designs, is indicated to explore long-term effects of serial casting on functional lower limb outcomes such as gross motor function in children with CP. Clinicians can use this information when developing individualised treatment plans for children who have CP during shared decision-making consultations.
