Serial casting is a procedure that helps children and adults improve their range of movement.

The procedure is the application of a fiberglass cast with padding to hold a part of the body in a position that will stretch a tight muscle. The cast is applied weekly and will stay on for 5-10 days maintaining the muscle in a stretched position. Sequential casts are done for up to three to six weeks to progressively stretch the joint and increase range of motion.

Who benefits from serial casting?

The serial casting program at Kennedy Krieger Institute can be done for any patient with muscle tightness and limited range of motion, but the most prevalent diagnoses are:

  • Cerebral palsy
  • Spina bifida
  • Brain injury
  • Spinal cord injury
  • Congenital abnormalities
  • Muscular dystrophy
  • Idiopathic toe walking
  • Peripheral neuropathy
  • Brachial plexus
  • Arthrogryposis
  • Syndactyly

What are the goals of serial casting?

  • Serial casting is a non-invasive approach to reduce the muscle tightness and limited range of motion of a joint to improve the patient's function.
  • Serial casting helps correct joint alignment so that the patient can be given the appropriate orthotic device or treatment.
  • Serial casting may help prevent deformity by allowing the patient to perform functional activities without restriction.
  • Serial casting can be a treatment choice to help plan possible upper extremity surgery or to postpone surgery by gaining range.
  • Serial casting may assist with goals of maintaining proper skin integrity, decrease pain, and to assist with ease of care for activities of daily living.
  • Serial casting is often used in conjunction with Botox intervention to gain muscle length and reduce tone.

What happens during a serial casting session?

Patient is evaluated by a physical or occupational therapist prior to the procedure. Trained therapists will apply the cast with proper padding to prevent skin irritation. The extremity will be casted in proper alignment at one or more targeted joints in the maximal available range of motion. Instruction about care of the cast and precautions will be reviewed with the family/caregiver and patient.

How long will I need to come for cast changes?

Casts will be changed on a weekly basis until the patient's range of movement progresses to their most functional level. Each patient responds differently to casting; therefore, the number of casts will be determined by the therapist. Generally, casting can last anywhere from three to six weeks.

What happens after the casting is finished?

The physician and the therapist determine what the patient's needs are regarding orthotics after casting. Orthotics are generally applied after the cast procedure is complete to help maintain the patient's range of motion.

How does serial casting affect the patient and family?

The casting procedure can take anywhere from one to three hours, depending on the response of the patient and the number and/or type of joint being casted. The patient is able to participate in school and other normal activities while the cast is on. The biggest challenge is keeping the cast dry, especially during the bathing process.