1. Effects of Casting on Ambulation in Children with Cerebral Palsy By: Aneta Petri & Katie Wilson Equinus Gait Pattern: Effects of Lower Limb casting on ambulation: Study Protocol: What Research Found : What Does this mean for Physical Therapy: What is Cerebral Palsy: Movement disorder affecting muscle tone and posture stability Caused by damage to the developing brain Non-progressive disorder Can be classified as spastic or hypotonic: Monoplegia, Diplegia, Hemiplegia, Quadriplegia. Refrences: 1. Anttila Heidi, Autti-Ra’mo Ilona, Ma’kela Marjukka, et al. Effectiveness of Upper and Lower Limb Casting and Orthoses in Children with Cerebral Palsy, An Overview of Review Articles Am J Phys Med Rehabil. 2006;85:89- 103.Available at: DOI:10.1097/01.phm.0000179442.59847.27. Accessed November 16, 2013. 2. Blackmore AM, Boettcher-Hunt E, Chan MDY, et al. A systematic review of the effects of casting on equinus in children with cerebral palsy: an evidence report of the AACPDM. J of Developmental Medicine & Child Neurology. 2007;49:781-790. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1469- 8749.2007.00781.x/pdf. Accessed November 8, 2013.http://onlinelibrary.wiley.com/doi/10.1111/j.1469- 8749.2007.00781.x/pdf 3. Charmet E, Chavrier Y, Cottalorda J, et al. Toe-walking in children younger than six years with cerebral palsy: THE CONTRIBUTION OF SERIAL CORRECTIVE CASTS. J Bone Joint Surg. 2000;82-B:541-544 4. Eve L.C, Gough M, Lin J.P, et al. The effect of serial casting on gait in children with cerebral palsy: preliminary results from a crossover trial. J of gait & Posture.2007;25:463-468. Available at: doi:10.1016/j.gaitpost.2006.08.002. Accessed November 8, 2013. Negative Effects of Casting ⁽ ² ⁾ : Tendonitis Weakness Cast breakdown Not enough evidence to support the use of casting alone over other forms of interventions ⁽ ² ’ ³ ’ ⁴⁾ Casting will not prevent surgery, but it can post- pone surgical intervention until child is older ⁽ ³ ⁾ Physical Therapists can help to prolong the effects of casting by passive stretching, active stretching, and neuromuscular re-education. ⁽ ² ’ ³ ’ ⁴⁾ Treatment of spastic Cerebral Palsy will vary based upon family and child individual needs ⁽ ² ’ ³ ’ ⁴⁾ Increase of plantarflexion with a limitation of dorsiflexion past the neutral position. ⁽ ² ’ ³ ⁾ Possible Causes: Overstimulation of the stretch reflex in the plantarflexor musculature, or contractures of the plantarflexors. ⁽ ³ ’ ⁴⁾ Two classifications of Equinus: Dynamic or Fixed ⁽ ² ⁾ Muscle deformities lead to an increase of weight bearing on the metatarsal heads during stance and ambulation. ⁽ ² ⁾ Further research is necessary to determine what physical therapy interventions are most effective for children with Cerebral Palsy. One study used a below the knee casting. Casts were placed in max passive dorsiflexion while the knee was bent at 90 degrees. The researchers changes casts each week until no change was noted or 10 degrees of dorsiflexion was reached. ⁽⁴⁾ A second study used the same protocol. Casts were changed every three weeks over a period of three months. ⁽³⁾ Systematic review showed a significant improvement in stride length ⁽ ² ⁾ Research indicated short term improvements in passive dorsiflexion when knee is in extension, long term improvements when knee is in flexion ⁽⁴⁾ Addition research studies indicate an increase in dorsiflexion ⁽ ¹ ’ ³ ⁾ -The benefits are short term with equinus returning within several participants Images from Blackmore AM et al. 2007 Skin Irritation Edema in foot/ankle Pain in lower leg Rearfoor varus Stiffness Contractures