What is serial casting?
Serial casting involves using a series of casts (either rigid or semi rigid) worn to hold and provide a sustained stretch to a muscle group which has become shortened as a result of muscle contracture or spasticity. 

Who may benefit?
People who have had long periods of immobility or people with neurological sensori-motor deficits caused by weakness or spasticity are at high risk of developing contractures and may benefit from casting. 

Tees Neuro Physiotherapy specialise in the management of Adult Rehabilitation only, for paediatric clients that may benefit from casting we would recommend speaking with a specialist paediatric team. 

What are the benefits of serial casting?
The benefits depend on the specific goal that has been mutually agreed between each client with their therapist. 

Quite often casting can compliment rehabilitation; for example, it may improve walking or upper limb function/cosmesis. Sometimes, casting is useful to prevent further decline to the musculature or joint capsule within a specific limb which may be impacting on everyday activities such as washing, dressing or manual handling tasks.

Many people that require serial casting will be receiving Botulinum Toxin, serial casting can hugely compliment the effects of Botulinum Toxin if timed accurately. 

How does the Physiotherapist put the cast on?
Casting often takes place in the clinic environment, however for people that are unable to attend clinic we can arrange for the casting to take place in the home environment. There will always be 2 staff members during the casting process. 

You may be asked to lie on your front or back or side depending on which limb is being casted. Your Therapist will be able to optimise the environment in order to get you into the best position for casting. Protective layers will be applied to the limb to protect the skin and then the cast material will be applied. It usually takes a maximum of 1 hour. 

What happens once the cast is on?
In general, mostly you will resume your usual activities…

You may shower with a waterproof cover in situ,  this can sometimes be tricky if you have mobility difficulties. Driving may also be difficult in some cases. Casting needs to be planned in advance to ensure that you have any additional support/ adaptations are made to support you in your usual routine. 

Your Therapist will advise you on how long each cast will need to remain in situ. Usually a cast would not remain in situ for any longer than 1 week. The number of casts required will depend on the progress made which will be monitored at each cast removal.

Monitoring
For the first 24 hours after application you must monitor and check that there is no vascular compromise…you will monitor

• Skin colour
• Swelling
• Temperature
• Pain

Cast Removal
Your Therapist will agree a date for the cast to be removed, the cast will be removed wither will plaster scissors or on occasions an oscillating plaster cast saw. If your cast requires removal earlier than the agreed date due to one of the above reasons you will need to attend your local plaster removal room at your closest hospital/urgent care centre

*Please inform your Therapist as soon as possible if the cast has been removed out of hours.

What happens once the casting process is complete?
The next steps will vary depending on your specific goal. Most people that require casting will continue with their rehabilitation. Your Therapist will monitoring your range of motion/muscle tone to ensure that the gains are maintained. Many people will require a removable orthosis in order to maintain the new range gained via the casting. On some occasions (especially weight-bearing joints) where range has been gained you may not require an orthosis as regular weight-bearing is sufficient. 

If the casting has not been successful then your Therapist will discuss the next steps with you on an individual basis. 

Cost
Cost will vary depending on which materials your Therapist considers the best materials to use for your cast. It will also depend on how many casts you require.  

Please do not hesitate to contact a member of our team to discuss whether serial casting may be appropriate for you or your relative/client.