【原创】脑瘫治疗 其他方法大观系列之 十七：Dynamic Splinting/ Serial Casting介绍
发布于 2008-03-06 · 浏览 564 · IP 美国美国
这个帖子发布于 17 年零 61 天前，其中的信息可能已发生改变或有所发展。
Dynamic Splinting/ Serial Casting
Description
Serial casting is a noninvasive procedure that helps children and adults improve their range of motion so they can perform daily activities with less difficulty. It is a process in which a well-padded cast is used to immobilize a joint that is lacking full range of motion. The cast will be applied and removed on a weekly basis. Each cast gradually increases the range of motion in the affected joint. Serial casting is often used in conjunction with Botox injections. Use of orthoses and splints is very common in CP. These devices can be used for protection/preventative reasons, as well as to provide increased support to improve mobility and efficiency of movement. Splints and orthoses are made to prevent contracture and enhance movement in both UEs and LEs, as well as to provide trunk/postural support for seating systems. We are focusing on the LEs.
Benefits of serial casting
• Non-surgical approach to reduce muscle tightness around a joint that is limiting ROM and functional mobility.
• Assists in achieving the optimum alignment of a joint. It also helps prepare a joint for the use of further orthopedic devices such as braces, splints, etc.
• May help decrease the chance of a deformity developing and/or progressing due to abnormal weight-bearing.
• Safe and effective way to increase ROM and improve functional mobility. It may help eliminate, delay, or minimize the need for surgical intervention.
Benefits of lower extremity orthoses
• Limit inappropriate joint movements and alignment
• Prevent contracture, hyperextensibility and deformity
• Enhance postural control and balance
• Enhance ambulation ability
• Provide post-operative protection of tissues
• Can be used during sleep
The process of serial casting
• Muscle strength and ROM of the affected joint are assessed prior to casting.
• Cast is applied in the joint’s optimal position and range.
• Instruction about care of the cast and precautions should be reviewed with the family and patient.
• Casts are changed on a weekly basis until a target ROM goal is achieved.
• Typically, the casting procedure is completed in 4-6 weeks.
• The healthcare team determines what may be needed in terms of orthotics (braces, splints, etc.) to maintain the newly gained ROM.
• A walking cast and cast shoe allow children to walk during the period of casting.
• Daily routines are not altered significantly and patients can stay active, participating in school and normal activities.
Evidence
• Cattalorda et al (2000): Improvements were observed in PROM DF immediately post-casting and at 3 years follow-up.
• Booth et al (2003): Using serial casting in conjunction with BtA may achieve ROM goals in less time vs. only using serial casting.
• Autti-Rämö et al (2005): casting of lower limbs has a short-term effect on improving PROM, orthoses that restrict PF have a favorable effect on equinus walk.
• Park et al (2004): Improvements of temporal, kinematic and kinetic parameters of sit-to-stand tasks were improved when children wore hinged AFOs.
• Baumann et al (1985): Use of foot orthoses as night splints from age three to the end of skeletal growth prevented calf muscle contracture and decreased need for surgeries.
• NIGHT SPLINTING
Study Limitations
• Need studies that follow children over longer periods of time
• Assess benefit of post-casting (ie. orthotics) to help maintain range of motion gained through casting.
• Studies assessing different types of braces/splinting/orthoses are inconclusive due to different presentations of CP and the many different types of orthotics available.
References
Baumann JU, Zumstein M. Experience with a plastic ankle-foot orthosis for prevention of muscle contracture. Developmental Medicine and Child Neurology. 1985; 27:83
Cottalorda J, Gautheron V, Metton G, Charmet E, Chavier Y. Toe-walking in children younger than six years with cerebral palsy: the contribution of serial corrective casts. Journal of Bone and Joint Surgery (British). 2000: 82B(4): 541-4
Booth MY, Yates CC, Edgar TS, Bandy WD. Serial casting vs. combined intervention with botulinum toxin A and serial casting in the treatment of spastic equines in children. Pediatric Physical Therapy. 2003; 15:216-220
Autti-Rämö I, Suoranta J, Anttila H, Malmivaara A, Mäkelä M. Effectiveness of upper and lower limb casting and orthoses in children with cerebral palsy. American Journal of Physical Medicine & Rehabilitation. 2005; 8: 89-103
Park ES, Park CI, Chang HJ, Choi JE, Lee DS. The effect of hinged ankle-foot orthoses on sit-to-stand transfer in children with spastic cerebral palsy. Archives of Physical Medicine and Rehabilitation. 2004; 85:2053-2057
Campbell SK, Vander Linden DW, Palisano RJ. Physical Therapy for Children. 3rd ed. St. Louis: Saunder, 2006.
Description
Serial casting is a noninvasive procedure that helps children and adults improve their range of motion so they can perform daily activities with less difficulty. It is a process in which a well-padded cast is used to immobilize a joint that is lacking full range of motion. The cast will be applied and removed on a weekly basis. Each cast gradually increases the range of motion in the affected joint. Serial casting is often used in conjunction with Botox injections. Use of orthoses and splints is very common in CP. These devices can be used for protection/preventative reasons, as well as to provide increased support to improve mobility and efficiency of movement. Splints and orthoses are made to prevent contracture and enhance movement in both UEs and LEs, as well as to provide trunk/postural support for seating systems. We are focusing on the LEs.
Benefits of serial casting
• Non-surgical approach to reduce muscle tightness around a joint that is limiting ROM and functional mobility.
• Assists in achieving the optimum alignment of a joint. It also helps prepare a joint for the use of further orthopedic devices such as braces, splints, etc.
• May help decrease the chance of a deformity developing and/or progressing due to abnormal weight-bearing.
• Safe and effective way to increase ROM and improve functional mobility. It may help eliminate, delay, or minimize the need for surgical intervention.
Benefits of lower extremity orthoses
• Limit inappropriate joint movements and alignment
• Prevent contracture, hyperextensibility and deformity
• Enhance postural control and balance
• Enhance ambulation ability
• Provide post-operative protection of tissues
• Can be used during sleep
The process of serial casting
• Muscle strength and ROM of the affected joint are assessed prior to casting.
• Cast is applied in the joint’s optimal position and range.
• Instruction about care of the cast and precautions should be reviewed with the family and patient.
• Casts are changed on a weekly basis until a target ROM goal is achieved.
• Typically, the casting procedure is completed in 4-6 weeks.
• The healthcare team determines what may be needed in terms of orthotics (braces, splints, etc.) to maintain the newly gained ROM.
• A walking cast and cast shoe allow children to walk during the period of casting.
• Daily routines are not altered significantly and patients can stay active, participating in school and normal activities.
Evidence
• Cattalorda et al (2000): Improvements were observed in PROM DF immediately post-casting and at 3 years follow-up.
• Booth et al (2003): Using serial casting in conjunction with BtA may achieve ROM goals in less time vs. only using serial casting.
• Autti-Rämö et al (2005): casting of lower limbs has a short-term effect on improving PROM, orthoses that restrict PF have a favorable effect on equinus walk.
• Park et al (2004): Improvements of temporal, kinematic and kinetic parameters of sit-to-stand tasks were improved when children wore hinged AFOs.
• Baumann et al (1985): Use of foot orthoses as night splints from age three to the end of skeletal growth prevented calf muscle contracture and decreased need for surgeries.
• NIGHT SPLINTING
Study Limitations
• Need studies that follow children over longer periods of time
• Assess benefit of post-casting (ie. orthotics) to help maintain range of motion gained through casting.
• Studies assessing different types of braces/splinting/orthoses are inconclusive due to different presentations of CP and the many different types of orthotics available.
References
Baumann JU, Zumstein M. Experience with a plastic ankle-foot orthosis for prevention of muscle contracture. Developmental Medicine and Child Neurology. 1985; 27:83
Cottalorda J, Gautheron V, Metton G, Charmet E, Chavier Y. Toe-walking in children younger than six years with cerebral palsy: the contribution of serial corrective casts. Journal of Bone and Joint Surgery (British). 2000: 82B(4): 541-4
Booth MY, Yates CC, Edgar TS, Bandy WD. Serial casting vs. combined intervention with botulinum toxin A and serial casting in the treatment of spastic equines in children. Pediatric Physical Therapy. 2003; 15:216-220
Autti-Rämö I, Suoranta J, Anttila H, Malmivaara A, Mäkelä M. Effectiveness of upper and lower limb casting and orthoses in children with cerebral palsy. American Journal of Physical Medicine & Rehabilitation. 2005; 8: 89-103
Park ES, Park CI, Chang HJ, Choi JE, Lee DS. The effect of hinged ankle-foot orthoses on sit-to-stand transfer in children with spastic cerebral palsy. Archives of Physical Medicine and Rehabilitation. 2004; 85:2053-2057
Campbell SK, Vander Linden DW, Palisano RJ. Physical Therapy for Children. 3rd ed. St. Louis: Saunder, 2006.
最后编辑于 2008-03-06 · 浏览 564
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