The goal of casting patients with spasticity is to inhibit tone, reduce spasticity and maintain (and/or increase) soft tissue length. In doing so, we increase the range of motion, allowing patients to use their limb during ADLs, as well as increase the opportunity for activation of the appropriate muscle group and promote neuromotor reeducation.
From a patient perspective, inhibitory casting can prevent and treat deformities of the skin and joints. It potentially boosts a patient’s self-esteem by positioning the limb in a more effective, functional, and “normal” posture. The increased range also allows patients to easily access and clean their affected limb.
To attain these results, we can employ an inhibitory casting program. Here are five clinical reasons to use inhibitory casting:
- Casting is practical and cost-effective. Patients do not need to leave the facility or miss any therapy time. Therapists can become proficient in casting in a relatively short period of time.
- Casting can improve patient outcomes, increase patient independence and encourage functional use of the affected extremity. Casting holds the joint in proper alignment to promote tissue lengthening and can be easily removed/turned into a splint for night use. Increased tissue length allows for better alignment during all weight-bearing activities. This increases the likelihood of achieving muscle activation in the involved extremity through specific sensory input.
- Casting increases the efficiency and effectiveness of the therapy program. Evidence shows casting is more effective than stretching in maintaining soft tissue length.1 If a muscle is in a lengthened position at the beginning of the treatment session, the therapist can start the session by jumping into neuroeducation.
- Casts are custom fit. They reduce the chances of pressure sores and allow for easy reapplication when a cast is bivalved into a splint.
- Casts are easily fabricated and removed. Adjustments are made as the patient progresses.
A casting program is an easy strategy to implement and can make an immediate difference in the lives of our patients!
- Pohl MD, Marcus, Stefan Ruckriem, MA, Jan Mehrholz, PT, Claudia Ritschel, PT, Herwig Strik, MD, MaxR. Pause, MD. Effectiveness of Serial Casting in Patients With Severe Cerebral Spasticity: A Comparison Study, "Arch Phys Med Rehabil Vol 83", June 2002, 784-790.
- Saracco Preissner, OTR/L, Kathy, The Effects of Serial Casting on Spasticity: A Literature Review, "Occupational Therapy in Health Care, Vol. 14(2)", 2001, 99-106.
- Carda, Stefano, Marco Invernizzi, Alessio Baricich, Carlo Cisari. Casting, taping or stretching after botulinum toxin type A for spastic equinus foot: a single-blind randomized trial on adult stroke patients. " Clinical Rehabilitation 25(12)", 2011, 1119–1127.
- Ho,Emily S., MEd, Trisha Roy, BA Sc, Derek Stephens, MSc, Howard M. Clarke, MD, PhD. Serial Casting and Splinting of Elbow Contractures in Children With Obstetric Brachial Plexus Palsy. "ASSH", 2010, 84-91.