Efficacy of Intermittent Serial Casting on Spastic Wrist Flexion Deformity
Condition: Cerebral Palsy
MeSH terms: Cerebral Palsy
Study type: Interventional
Phase: Phase 3

Summary: 
      Spastic wrist flexion deformity is a very common problem in children with CP. Although serial
      casting (SC) is one of the commonly used interventions in addition to botulinum toxin A
      (BoNT-A) injections and physical therapy for spastic deformities of lower extremity of
      children with CP, there is limited data on SC in the upper extremity.

      In this prospective, randomized, controlled clinical trial in order to overcome the issues
      with patient compliance, side effects and combined treatment options an intermittent SC model
      was developed. The objective of this study was to show the effects of intermittent SC when
      combined with occupational therapy (OT) and BoNT-A injections on spasticity, and passive
      range of motion (pROM) of children with CP having spastic wrist flexion deformity.
    

Detailed description: 
      Spasticity is not only the most common motor disorder but also the main cause of slowly
      developing secondary problems like contractures in children with cerebral palsy (CP). Spastic
      wrist flexion deformity is a very common problem in children with CP and can be primarily due
      to spasticity of the palmar muscle complex, can be exacerbated by the weakness of the
      antagonist dorsiflexor muscles and can involve soft tissue and joint contractures. Although
      serial casting (SC) is one of the commonly used interventions in addition to botulinum toxin
      A (BoNT-A) injections and physical therapy for spastic deformities of lower extremity of
      children with CP, there is limited data on SC in the upper extremity. Skin irritation or
      breakdown, painful epizodes, oedema, tendonitis, weakness, stiffness are some of the side
      effects reported after SC. Moreover casting especially when prolonged might complicate
      activities of daily living for instance by increasing the risk of falls or causing problems
      in bathing. Recent evidence from literature favors early, goal oriented, activity based,
      intensive, repetitive motor trainings in enriched environments to optimize neuroplasticity in
      children with CP. Prolonged serial casting might also interfere with these activity based,
      intensive rehabilitation options for upper extremity.

      In this prospective, randomized, controlled clinical trial in order to overcome the issues
      with patient compliance, side effects and combined treatment options an intermittent SC model
      was developed. The objective of this study was to show the effects of intermittent SC when
      combined with occupational therapy (OT) and BoNT-A injections on spasticity, and passive
      range of motion (pROM) of children with CP having spastic wrist flexion deformity.
    

Intervention name(s): Botulinum toxin A; Occupational Therapy; Intermittent serial casting
Intervention type(s): Drug; Other; Other
Other intervention name(s): Dysport
Intervention MeSH terms: Botulinum Toxins; Botulinum Toxins, Type A; abobotulinumtoxinA
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: cerebral palsy; casting; Botulinum toxin A