| Author, Year
Country
Study Design
Sample Size |
Methods |
Outcome |
| Moseley et al. (2008)
RCT
PEDro=8
N=26 |
Population: TBI; Positioning Group (n=12): Gender: Male=11, Female=1; Mean Age=30.8yr; Median Time Post Injury=71d; Median Glasgow Coma Scale (GCS) score=3. Serial Casting Group (n=14): Gender: Male=12, Female=2; Mean Age=32.3yr; Median Time Post Injury=59d; Median GCS score=4.5.
Intervention: Participants were randomized to one of two interventions for elbow flexion contracture: serial casting or passive stretch (positioning group). Those in the serial casting group had long arm synthetic casts applied for 2wk with the elbow in a stretched position. Casts were changed to progress the stretch. After 2wk, the cast was removed, and the participants underwent passive stretching 1hr/wk for 4wk. The second group had passive stretch applied to the elbow flexor muscles for 1hr/day, 5 x/wk.
Outcome Measure: Torque controlled passive elbow extension,Modified Tardieu Scale. |
1. Stretching group received a mean of 13 hr of stretching during the intervention and the serial casting had stretch applied for a mean of 13.6 days.
2. Those in the serial casting group had a greater reduction in contracture in the short term: serial casting reduced contracture by a mean of 22º (p<0.001) when compared to the positioning group. The next day the mean reduction was only 11° for the casting group, and differences between groups were less (p=0.052).
3. At follow up assessment, there was no significant or clinically meaningful difference between groups (mean effect 2°, p=0.782).
4. When looking at spasticity the serial casting group had slightly lower spasticity than the stretching group (p<0.05). |
| Moseley (1997)
Australia
RCT
PEDro=4
N=9 |
Population: TBI; Mean Age=29.1yr; Gender: Male=8; Female=1; Time Post Injury=72.2d.
Intervention: Subjects in the experimental group received a below-knee cast and stretched for 7d. The control group did not receive a cast or stretching. Participants then received the other intervention.
Outcome Measure: Passive ankle dorsiflexion (PAD) movement. |
1. PAD movement increased (mean: 13.5°) during intervention compared to a decrease (mean: 1.9°) shown for the control condition (p<0.05). Mean difference between conditions was 15.4°. |
| Singer et al. (2003)
Australia
Pre-Post
N=9
|
Population: Stroke=3, Subarachnoid Hemorrhage=4, Intra-cerebral Hemorrhage=1, Diffuse Axonal Injury=1; Mean Age=30.7yr; Gender: Male=6, Female=3; Mean Time Post Injury=3.9mo.
Intervention: A serial casting procedure addressing extensibility, passive resistance torque and stretch reflex response of the ankle was implemented. Casts were applied weekly and continued until goal was reached or no measurable gain recorded.
Outcome Measure: Maximal Passive Range of Motion, Transfer Dependency, and Rancho Los Amigos Levels of Cognitive Functioning (RLA). |
1. Post-casting, all subjects had at least 10° dorsiflexion with the knee flexed and 6 had maximal passive range of motion of 10° dorsiflexion with knee extended.
2. Muscle extensibility and passive torque improved significantly (p<0.0001). Functional range was maintained in 8 subjects at 6mo follow-up.
3. All participants improved RLA scores by at least one point.
4. Significant improvements were noted for transfer dependency scores from initial to post intervention (p<0.0015).
Casting did lead to some tissue breakdown. |
| Pohl et al. (2002)
Germany
Case Control
N=105
|
Population: TBI=43, Stroke=19, Intracerebral Hemorrhage=19, Cerebral Hypoxia=11, Subarachnoid Hemorrhage=6, Other=7; Gender: Male=81, Female=24. Control Group (n=56): Median Age=38.2yr. Intervention Group (n=49): Median Age=44.6yr.
Intervention: A stepwise reduction of fixed, flexed joint contracture via serial casting. Patients were treated with conventional casting changing intervals of 5-7d (control) or 1-4d (Intervention), to maximum possible extension (<10% of extension deficit) or when extension deficit fails to reduce after two cast changes.
Outcome Measure: Maximum deficits of different joints (elbow, wrist, knee, ankles), Range of Motion (ROM), Number of Complications. |
1. The median change interval was 6.9 days for 92 joints of 56 control group patients.
2. The median change interval was 2.7 days for 80 joints of 49 intervention group patients.
3. Mean casting time in the control and intervention group was 32.6±20.6 days and 9.3±5.6 days, respectively.
4. ROM improved after casting and 1mo follow-up in both groups (p<0.001) but no between group differences were found (p=0.72).
5. Casting complications differed between groups 1 and 2 (29.3% versus 8.8%, p=0.001). |
