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 increased joint range, muscle extensibility and reduced reflex excitability are outlined in this review. Support for these mechanisms stems largely from animal experimental studies. The applicability of these data to human muscle is unknown. Issues: Equino-varus deformity of the ankle is a common secondary complication of acquired brain injury. It results from a combination of sequelae of the brain injury and subsequent immobility, including hypertonia, reduced muscle length and increased stiffness. Some evidence exists for the efficacy of serial plaster casts in the treatment of equino-varus deformity, although most reported studies are uncontrolled and involve small numbers of subjects. Serial casting has been shown to result in decreased resistance to passive lengthening and a reduction in dynamic reflex excitability within the lengthened 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 aimed at improving functional mobility. A variety of therapeutic interventions have been used to augment the effect of the casting regime. Factors that have been demonstrated to be associated with a favourable outcome from serial casting, and recommendations for future research are also discussed in this review.