Effects of Casting on Ambulation in Children with Cerebral Palsy By: Aneta Petri & Katie Wilson

1. Effects of Casting on Ambulation in Children with Cerebral Palsy By: Aneta Petri & Katie Wilson What Does this mean for Physical Therapy: Effects of Lower Limb casting on ambulation: Study Protocol: What Research Found: • What is Cerebral Palsy: • Movement disorder affecting muscle tone and • posture stability • Caused by damage to the developing brain • Non-progressive disorder • Can be classified as spastic or hypotonic: • Monoplegia, Diplegia, Hemiplegia, • Quadriplegia. • Physical Therapists • can help to prolong the • effects of casting by • passive stretching, • active stretching, and • neuromuscular • re-education. ⁽²’³’⁴⁾ • One study used a below the knee casting.  Casts were placed in max passive dorsiflexion • while the knee was bent at 90 degrees.  The researchers changes casts each week until no • change was noted or 10 degrees of dorsiflexion was reached.⁽⁴⁾ • A second study used the same protocol.  Casts were changed every three weeks over a • period of three months.⁽³⁾ • Systematic review showed a significant improvement in stride length⁽²⁾ • Research indicated short term improvements in passive dorsiflexion when knee is in extension, long term improvements when knee is in flexion⁽⁴⁾ • Not enough evidence to support the use • of casting alone over other forms of • interventions ⁽²’³’⁴⁾ • Addition research studies indicate an increase in dorsiflexion⁽¹’³⁾ • -The benefits are short term with equinus returning • within several participants • Casting will not prevent surgery, but it can post- • pone surgical intervention until child is older⁽³⁾ Equinus Gait Pattern: • Increase of plantarflexion with a limitation of • dorsiflexion past the neutral position. ⁽²’³⁾ • Treatment of spastic Cerebral Palsy will vary • based upon family and child individual needs⁽²’³’⁴⁾ • Further research is necessary to determine what • physical therapy interventions are most • effective for children with Cerebral Palsy. • Possible Causes: Overstimulation of the stretch reflex in the plantarflexor musculature, or contractures of the plantarflexors. ⁽³’⁴⁾ Refrences: 1. Anttila Heidi, Autti-Ra’moIlona, Ma’kelaMarjukka, et al. Effectiveness of Upper and Lower Limb Casting and Orthoses in Children with Cerebral Palsy, An Overview of Review Articles Am J Phys Med Rehabil. 2006;85:89- 103.Available at: DOI:10.1097/01.phm.0000179442.59847.27. Accessed November 16, 2013. 2. Blackmore AM, Boettcher-Hunt E, Chan MDY, et al. A systematic review of the effects of casting on equinus in children with cerebral palsy: an evidence report of the AACPDM. J of Developmental Medicine & Child Neurology. 2007;49:781-790. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.2007.00781.x/pdf. Accessed November 8, 2013. 3. Charmet E, Chavrier Y, Cottalorda J, et al. Toe-walking in children younger than six years with cerebral palsy: THE CONTRIBUTION OF SERIAL CORRECTIVE CASTS. J Bone Joint Surg. 2000;82-B:541-544 4. Eve L.C, Gough M, Lin J.P, et al.The effect of serial casting on gait in children with cerebral palsy: preliminary results from a crossover trial. J of gait & Posture.2007;25:463-468. Available at: doi:10.1016/j.gaitpost.2006.08.002. Accessed November 8, 2013. • Two classifications of Equinus: Dynamic or • Fixed ⁽²⁾ • Muscle deformities lead to an increase of • weight bearing on the metatarsal • heads during stance and ambulation. ⁽²⁾ Images from Blackmore AM et al. 2007 Negative Effects of Casting⁽²⁾: • Skin Irritation • Edema in foot/ankle • Pain in lower leg • Tendonitis • Weakness • Cast breakdown • Rearfoorvarus • Stiffness • Contractures