Serial plaster casting to correct equino-varus deformity of the ankle following acquired brain injury in adults

Purpose: Proposed mechanisms via which serial casting might effect increase d joint range, muscle extensibility and reduced reflex excitability are out lined in this review. Support for these mechanisms stems largely from anima l experimental studies. The applicability of these data to human muscle is unknown. Issues: Equino-varus deformity of the ankle is a common secondary complicat ion of acquired brain injury. It results from a combination of sequelae of the brain injury and subsequent immobility, including hypertonia, reduced m uscle length and increased stiffness. Some evidence exists for the efficacy of serial plaster casts in the treatment of equino-varus deformity, althou gh most reported studies are uncontrolled and involve small numbers of subj ects. Serial casting has been shown to result in decreased resistance to passive lengthening and a reduction in dynamic reflex excitability within the lengt hened muscles in children with cerebral palsy. Currently documented effects of serial casting in brain injured adults are limited to changes in range of maximal passive dorsiflexion. Conclusion: Serial casting should be considered as an adjunct to therapy ai med at improving functional mobility. A variety of therapeutic intervention s have been used to augment the effect of the casting regime. Factors that have been demonstrated to be associated with a favourable outcome from seri al casting, and recommendations for future research are also discussed in t his review.