Serial Casting

What are some reasons that someone would get serial casting?

• Ortho

  • Improve muscle length

  • Increase joint PROM

• Neuro

  • Improve weight bearing for transfers

  • Relieve pain

  • Decrease contractures

  • Decrease muscle tone and influences on positioning

What diagnoses are most likely to get serial casting?

• Toe walkers

• CP

• Neurofibromatosis

• GB

• TBI

• SCI

• Spina bifida

• Club foot

What are some contraindications to serial casting?

• Active infection

• Fracture

• Pre-existing or uncontrolled swelling

• Open wound

What are some precautions to serial casting?

• Non-verbal

• Impaired/absent sensation

• Known skin integrity challenges

In what position should a pt be when you are applying a cast around the foot and ankle up to just below the knee?

Prone

Before doing a serial cast, what do you need a prescription for?

Casting

Why should the casted extremity be periodically elevated?

To reduce swelling

You are NOT allowed to stand or walk on a serial cast. True or false?

False! It’s actually encouraged

A child with a serial cast can go swimming with no additional equipment, the casts are waterproof. True or false?

False, those casts gotta remain dry

You have had a pt in a serial cast for a week. When they come back the next week, what are some things that you may see that you make you think you should not cast them again?

• Refusal to bear weight on casted extremity

• Cracks/dents in the cast

• Negative changes in sleeping/mood

• Dampness

• Slipping/shifting in cast

• Redness/chaffing without significant swelling or skin breakdown

• Skin reaction

• Knowledge of objects dropped in cast

What are some indications that a cast should be immediately removed?

• Poor circulation in the casted extremity shown by a weak pulse, abnormal capillary refill, or toes that are cold to the touch

• Evidence or severe complaints of pain and point tenderness

• Cast is wet

How many weeks does someone normally go through series casting?

6-12 wks

If someone has a serial cast on their LE, how should they be sitting?

Long sitting

After a pt gets done with casting, what are the focuses of phase 1 of rehab?

• Desensitization

• New postural alignment and awareness

• New motor plan with ankle dorsiflexion

After a pt gets done with casting, what are the focuses of phase 2 of rehab?

• Functional transitions and movement with full available ankle dorsiflexion AROM

• Dynamic balance

After a pt gets done with casting, what are the focuses of phase 3 of rehab?

• Return to PLOF with new motor pattern

• Age-appropriate gross motor milestones