Reduction of hypertonicity by early casting in a comatose head-injured individual. A case report

The patient in this report sustained a closed-head injury. Within six days of the injury, he demonstrated generalized hypertonicity accompanied by alternating strong decerebrate and decorticate posturing. By Day 10 after injury, normal passive ROM could no longer be maintained using neurophysiological therapeutic techniques. Therefore, we applied plaster casts to both ankles. Within 24 hours of cast application, the patient's general hypertonus had decreased, and by 72 hours after casting, the patient demonstrated seemingly purposeful movements of the left extremities. Although casts have been used previously to maintain ROM or decrease contractures and to improve balance of muscle function of the joint that was immobilized, we believe that the marked, generalized reduction in tone in body segments far removed from the ankles was an important clinical observation. We explored several possible mechanisms for these observations. Because the usual casting conditions for reflex inhibition were not obtained with this patient, other factors were suggested to be important: total even pressure and neutral warmth. Research is currently in progress at the Medical Center Hospital of Vermont to study further the effects of plaster casting and to understand the mechanisms underlying the effects.