Designed to stretch tight muscles, serial casting treatments aim to increase range of motion in a particular joint. At Children’s Private Physiotherapy, in Wellingborough, Northamptonshire, we offer serial casting treatments for our young patients. It involves the application of specialist material called soft cast, or scotch cast, along with other material that provides adequate padding and protection for bony prominences. The cast is usually replaced every 7 days, and the whole treatment regime can run for up to 4 weeks. The treatment is primarily used in cases where muscle tightness is common, such as cerebral palsy sufferers, patients with a brain injury, and, in some cases, people with Idiopathic toe walking. It is also used post-operatively to stretch the musculotendinous structures and post-botox for gaining maximum muscle length.
Changing the length of the muscle should allow your child to function using the correct patterns of movement. For example, if the casting is applied to increase the range of motion in the calf, your child should be able to walk with either the heel touching the floor or being closer to the floor than before casting. It also improves standing and walking posture, as the foot is placed in a better position. Furthermore, the brain is provided with the correct movement feedback, which helps in motor learning and leads to increased chances of using the correct movement patterns in the future. In some cases, it might help in preventing the tightness from progressing further. There will also be an improvement in balance and coordination and you will notice an overall improvement in your child’s everyday activities.
The physiotherapist will measure the range of motion in the joint to be casted before starting the procedure and every time the cast is changed. There should be an increase in joint range of motion at every cast change. They will discuss with you the functional goals which your child should be able to achieve after the completion of treatment.
In most cases, splints are provided to maintain the length of the muscle. It might take a while to get adapted to the increase in range of motion, and there could be a brief period where your child might feel unsteady. An intensive exercise programme will be provided to strengthen the muscles so the obtained range of motion and the benefits of casting can be maintained.
Your child will be provided with a shoe for wearing over the cast. They should not try to run or jump. They will not be able to go swimming and precautions should be taken to keep the cast dry while having a bath.
Make sure your child does not stick anything between the cast and their leg, as this might loosen it, reducing its effectiveness. It might also cause skin irritation, leading to removal of the cast earlier than intended.
Some children might feel an itching sensation due to skin irritation. On rare occasions, if the cast comes in contact with bony prominences, the skin might blister. This will cause pain and the cast will have to be removed. Regularly check the toes for any signs of discolouration (bluish appearance) or swelling. Also, there should not be any numbness or tingling sensation in the toes. In the event of any of the above, the cast should be immediately removed by soaking it in water and then unwrapping it layer by layer. If you are unable to remove the cast, or discolouration of toes and tingling sensation persists after removing, then it’s advisable to attend accident and emergency.