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

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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