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Intermittent serial casting for wrist flexion deformity in children with spastic cerebral palsy: a randomized
Nigar Dursun1, Tugba Gokbel1, Melike Akarsu1
1Faculty of Medicine Department of Physical Medicine and Rehabilitation, Kocaeli University, Kocaeli, Turkey.
Insights
Intermittent serial casting, combined with botulinum neurotoxin A (BoNT-A) and occupational therapy, offers significant benefits for children with cerebral palsy (CP) and spastic wrist flexion. This approach improves range of motion, muscle tone, and spasticity more effectively than BoNT-A and therapy alone.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Orthopedics
Background:
- Cerebral palsy (CP) frequently causes spastic wrist flexion deformity.
- Current treatments include occupational therapy and botulinum neurotoxin A (BoNT-A) injections.
- The potential additive benefit of serial casting requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of intermittent serial casting as an adjunct to occupational therapy and BoNT-A in children with CP.
- To assess the impact on spastic wrist flexion deformity.
Main Methods:
- A controlled, prospective study involving 34 children with CP.
- Random allocation to a casting group (intermittent serial casting + BoNT-A + occupational therapy) or a control group (BoNT-A + occupational therapy).
- Outcome measures included passive range of motion (PROM), muscle tone (Modified Ashworth Scale - MAS), and spasticity (Tardieu Scale) assessed at baseline, week 4, and week 12.
Main Results:
- Both groups showed significant improvements in PROM, MAS, and Tardieu Scale (XV3) after treatment.
- The casting group demonstrated statistically superior improvements in MAS (week 12), PROM, Tardieu XV3, and spasticity grade (Y) (weeks 4 and 12) compared to the control group.
- Baseline characteristics were comparable between groups.
Conclusions:
- Intermittent serial casting, when combined with BoNT-A and occupational therapy, provides additional benefits for children with CP and spastic wrist flexion deformity.
- Serial casting is a potentially valuable complementary treatment for children with significant PROM limitations.
Aim:
To assess the efficacy of intermittent serial casting in conjunction with occupational therapy and botulinum neurotoxin A (BoNT-A) in children with cerebral palsy (CP) presenting spastic wrist flexion deformity.
Method:
This was a controlled, prospective study in which 34 children (19 females, 15 males; mean [SD] 11y [4y 6mo]) were randomly allocated to casting or control groups in a ratio of 2:1. Both groups were subjected to BoNT-A treatment and occupational therapy. The casting group additionally received a series of progressive casts intermittently for three consecutive weekends. Outcome measures consisted of passive range of motion (PROM) as assessed by goniometer, muscle tone by Modified Ashworth scale (MAS), and spasticity by Tardieu Scale. Assessments were done at baseline, week 4, and week 12.
Results:
Baseline characteristics of casting and control groups were comparable. PROM, MAS, and Tardieu angle of catch (XV3) of the casting and control groups significantly improved after treatment (p<0.001 for all). Nevertheless the mean change from baseline MAS at week 12, mean changes from baseline PROM, Tardieu XV3, and the spasticity grade (Y) at week 4 and week 12 of the casting group showed statistical superiority over those of the control group (p<0.05 for all).
Interpretation:
Children with CP presenting spastic wrist flexion deformity might gain additional benefits from supplementary intermittent serial casting as well as BoNT-A injections and occupational therapy. Serial casting could be considered as a complementary treatment to BoNT-A and occupational therapy in children with clinically significant PROM limitations.
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