OVERVIEW.

A cast is a rigid casing applied around a body part.¹ Serial casting involves recasting over time and is used to treat contractures by affecting muscle length, soft tissue extensibility, and possibly affecting muscle spindle excitability. The applied load on soft tissue is low and duration is long (i.e., not a quick stretch). Casting of burns offers plastic deformation of connective tissue, biomechanical realignment of joint structures, and protection of exposed tendons, fragile skin, or wounds.

SUMMARY: CONTRAINDICATIONS AND PRECAUTIONS.

Four sources (one burn- and three neurologically related) cited a total of 25 concerns for casting. Concerns ranged from 4 to 13 per source with the burn source citing the largest number. The largest proportion of concerns was procedural (about 45%). Six shared concerns (by two sources) were agitation, allergies, fragility, heterotopic ossification, excessive edema, and open wounds.

In a 2002 retrospective study, Pohl et al found fewer complications (i.e., ulcers, pain, swelling) in patients with cerebral spasticity when short intervals between serial casting were used.²

OVERVIEW.

An orthosis is an external device that is worn on a body part to support, correct, or prevent deformities or to align body structures for improved function.¹ Webster’s dictionary² defines it as a straightening treatment for the maladjusted. The term splint varies in meaning and may refer to either a hand orthosis³ or a temporary external device.¹ Some examples of orthoses include body jackets, hand splints, ankle foot orthoses, knee cages, elastic stockings, and corrective shoes.

SUMMARY.

Concerns for spinal and lower and upper limb (including hand splints) orthotics are varied and depend in large part on the patient’s clinical presentation and involved body region. Skin monitoring is recommended in most, if not all, orthotic applications. In general, orthotic concerns include skin ulceration in insensate or poorly vascularized skin, skin allergies from splint materials, contracture promotion (e.g., using UE slings in persons with UMN lesions), worsened spasticity (e.g., using dynamic splints in persons with UMN lesions), and orthotics that either fail to adequately stabilize critical body segment (e.g., high cervical fracture) or fail to control a crucial movement component (e.g., deleterious rotational forces). In addition to pressure ulcer complications, pressure-related neuropathies^4,5 and compartmental syndromes⁶ have been reported with orthotic use.