casting

Why would casting be used for tightness/spasticity?

lenghten/elongate muscle to increase range and reduce spasticity

What is the modified ashworth scale level 0?

no increased tone

What is the modified ashworth scale level 1?

slightly increased tone, min resistance at end

What is the modified ashworth scale level 1+?

slightly increased tone, min with less than half rom

What is the modified ashworth scale level 2?

increased time through range, easily moved

What is the modified ashworth scale level 3?

considerable increase, passive movement difficult

What is the modified ashworth scale level 4?

ridgid

What is the modified tardieu scale quality of muscle reaction level 0?

no resistance

What is the modified tardieu scale quality of muscle reaction level 1?

slight resistance then release

What is the modified tardieu scale quality of muscle reaction level 2?

clear catch interrupting range with release

What is the modified tardieu scale quality of muscle reaction level 3?

< 10 sec clonus

What is the modified tardieu scale quality of muscle reaction level 4?

> 10 sec clonus

What is the modified tardieu scale measuring spasticity R1?

angle of muscle reaction

V3 = move extremity as fast as possible through movement

What is the modified tardieu scale measuring spasticity R2?

full ROM

V1 = move extremity as slow as possible

What is the modified tardieu scale large R2-R1 difference?

better response to intervention

What is the modified tardieu scale small R2-R1 difference?

consistent with a fixed muscle contracture

What is passive stretching?

slow, passive ROM

acute injuries or limited increase in tone

What is passive lengthening?

holding limb in position in max range

changes the muscle itself

What is serial casting?

provides prolonged stretch through cast

increases ROM

prevents joint contractures

decreases need for surgical intervention

What is baclofen?

supports management of hypertonia

What is botox?

temp releif of hypertonia

temporarily paralyzes and weakens the muscle

What are indications for serial casting?

decreased ROM

persistent hypertonicity/spasticity

poor joint alignment

shortened soft tissue

risk of deformity

cant be controlled with just splinting

What are precautions for serial casting?

allergies

decreased sensation

poor communication

excessive sweating

sensory issues

decreased compliance ce

healing of fracture

What are contraindications for serial casting?

skin integrity

HTN

autonomic storming

edema in extremity

poor bone density

impaired circulation

fixed contractures

What is the serial casting protocol?

apply in series

one cast is 3-7 days

re assess ROM

check skin

if skin good apply new cast

once full ROM or plateau done with casting

What are precautions after casting?

discoloration

decreased pulse

temperature

pain

swelling

wetness/odor

itching

How is ROM maintained after casting?

bivalve/splints

ROM exercises

What is a bivalve?

made from final cast, cut into halves and velcro

What is a soft cast?

in emergence can remove

can remove prior to return

takes longer to harden

can be too soft to hold position

What is a hard cast?

position can be maintained

uncomplicated

need to go to ED for emergency removal