DR. SHWETA BHANDARI *
DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION
SMS MEDICAL COLLEGE AND HOSPITALS
Cerebral palsy is a range of non-progressive syndromes of posture and motor impairment resulting from an insult to developing central nervous system.
Management of spasticity is crucial in cerebral palsy as it affects the functional status of the child. Various treatment modalities are available to reduce the spasticity. In the department of Physical Medicine & Rehabilitation, S.M.S. Medical College, Jaipur; a longitudinal study is being carried out from July 2004 to evaluate the effect of serial casting in spastic cerebral palsied children.
All the children received weekly cast for 4 weeks and similar exercise programme. They were made ambulatory on II/III day of cast application and encouraged for reciprocal walking with supportive aid.
In all the children pre-cast, post-cast and on successive follow-up flexion & abduction over hip, flexion over knee and ankle dorsiflexion with knee extension & flexion were measured. Spasticity was measured by Modified Ashworth Scale. There was improvement in hip flexion deformity (12.16º to 2.33º), popliteal angle (68º to 20º), ankle dorsiflexion with knee extension (7.16º to 17.16º) and with knee flexion (21.16º to 29.83º).
Out of 16 children, 9 came for
follow-up for an average duration of 4.27 months (1-10 months). It was observed that correction was maintained at follow-up but to a lesser extent than post-cast status.
There was reduction in spasticity and deformities at various joints along with improvement in range of motion which ultimately led to a better functional status. Therefore, serial casting is a simple and safe method. It is well tolerated by children and accepted by parents. Above all, it is very cost-effective in developing countries like India.
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