Serial Casting
Serial casting involves applying progressive casts to stretch tight muscles and improve joint alignment. Used often after Botox, this technique reduces spasticity, enhances mobility, and prevents contractures. Tailored to individual needs, it supports long-term function through a controlled, evidence-based process.
Upper Limb Serial Casting
Serial casting involves applying progressive casts to stretch tight muscles and improve joint alignment. Used often after Botox, this technique reduces spasticity, enhances mobility, and prevents contractures. Tailored to individual needs, it supports long-term function through a controlled, evidence-based process.
Understanding Muscle Stiffness in Neurological Conditions
For people with neurological conditions like cerebral palsy, stroke, or acquired brain injury (ABI), muscles can become overly tight or stiff due to increased muscle tone. This stiffness often affects the arms or hands and can lead to several challenges:
Awkward Positioning: The hand or arm may not rest in a natural or useful position, making movement difficult.
Pain: Tight muscles can cause discomfort or soreness.
Contractures: Over time, muscles may shorten permanently, locking the arm or hand in a bent or fixed position and limiting motion.
How Is This Usually Managed?
Therapists often recommend splints or stretching exercises to keep muscles flexible and reduce stiffness. However, when muscles are very tight or contractures are starting to form (or have already set in), these methods can be hard to use effectively. Poorly fitting splints may even cause pressure sores if the arm’s shape or muscle length has changed.
What Happens When Contractures Develop?
If contractures become severe, the arm or hand may stay stuck in a bent or shortened position, making it impossible to straighten. This can seriously impact daily life, such as:
Everyday Tasks: Activities like eating, writing, or dressing become much harder or impossible.
Personal Care: Cleaning or caring for the affected limb gets tricky, which can affect hygiene and comfort.
When Is Serial Casting Helpful?
When splints and stretching aren’t enough, serial casting is a great option. It’s a gentle, step-by-step process that uses casts to gradually stretch tight muscles. Serial casting can:
Ease muscle stiffness.
Prevent or reverse contractures.
Reduce pain.
Improve movement and function.
Often, therapists pair serial casting with Botulinum Toxin (Botox) injections. Botox relaxes the muscles, making the casting process more comfortable and effective.
What Is Serial Casting?
Serial casting is a treatment where a series of lightweight casts are applied to the affected arm or hand over several weeks. Here’s how it works:
A therapist or specialist puts on a cast that holds the limb in a slightly stretched position.
Every few days, the old cast is removed, and a new one is applied to stretch the muscle a bit more.
This gradual process helps improve flexibility, correct positioning, and manage tightness.
The goal is to make the limb more comfortable and usable, step by step.
Why Use Serial Casting for Neurological Conditions?
1. Management of Spasticity:
Purpose: Neurological conditions can lead to spasticity, where muscles contract involuntarily. This can result in joint contractures, where the joint becomes fixed in a certain position.
Effect: Casting helps in reducing muscle tone and preventing or reversing contractures by maintaining the limb in a stretched position, which over time can lead to muscle lengthening.
2. Improve Range of Motion:
Purpose: Lack of movement due to neurological damage can lead to a decrease in joint mobility.
Effect: Serial casting provides a gentle, continuous stretch to the muscles and tendons, encouraging an increase in joint range of motion. This can be crucial for daily activities involving the hands and arms.
3. Prevent Deformity:
Purpose: Many neurological conditions can cause progressive deformities due to improper muscle balance or tone, such as swan-neck and boutonnieres finger deformities.
Effect: By applying casts that position the limb correctly, serial casting can prevent these deformities from worsening or even correct minor deformities.
4. Enhance Functionality:
Purpose: Improving the physical structure of the limb can lead to better functional outcomes.
Effect: With improved alignment and reduced spasticity, individuals might regain or enhance their ability to perform tasks like writing, eating, or dressing. To achieve this, it is important to strengthening the opposite muscle groups during and/or following serial casting.
5. Pain Management:
Purpose: Spasticity and fixed joint positions can cause significant pain.
Effect: By reducing muscle tension and correcting joint alignment, serial casting can decrease discomfort and pain associated with these conditions.
Process of Serial Casting
Assessment: A thorough evaluation by an occupational therapist to determine the need, potential benefits, and the correct positioning for casting.
Casting: Application of the initial cast, which is often done following botulinum toxin injections to ensure comfort, especially in cases with severe spasticity.
Monitoring: Regular checks to assess skin integrity under the cast, pain levels, and effectiveness is required.
Recasting: Casts are changed periodically (usually every few days) to further stretch the muscles or to hold the gained position.
Maximizing the Benefits of Casting
Casting is a valuable approach to help manage muscle tightness and contractures in people with neurological conditions. While it’s not a permanent solution for stiffness and may need to be repeated periodically throughout a person’s life, it can be highly effective for many. By quickly reducing muscle tension, casting creates an opportunity to fit more comfortable splints and improve arm and hand function while the muscles are more relaxed.
Follow-up Program:
To fully leverage the benefits of casting, a comprehensive follow-up program is essential. This could involve:
Splinting: Wearing custom-made splints to maintain the gains in muscle length.
Strength Training: Focusing on strengthening the muscles that oppose those prone to tightness.
Movement Therapy: Regularly moving the arm and hand through their full range of motion to prevent future contractures.
Functional Activities: Engaging the arm and hand in various daily tasks to promote practical use.
Your occupational therapist will work with you to tailor a follow-up program that helps sustain the improvements achieved through serial casting
