The influence of illness duration and level of consciousness on the treatment effect and complication rate of serial casting in patients with severe cerebral spasticity

Abstract

Objective: To compare the improvement and complication rates for serial casting in patients with shorter as opposed to longer illness duration, and in patients with lower as opposed to higher levels of consciousness. Design: A retrospective case-comparison study. Setting: A rehabilitation centre for adult persons with neurological disorders. Subjects: Sixty-eight patients with cerebral spasticity of different aetiologies were treated with serial casting to relieve fixed contractures. Intervention: Serial casting with either <90 days (group A, 36 joints, 24 patients) or 390 days (group B, 85 joints, 44 patients) duration of illness and either <12 (group 1, 49 joints, 25 patients) or 312 (group 2, 72 joints, 43 patients) Glasgow Coma Scale (GCS) scores. Main outcome measures: Percentage of normal maximum range of motion (ROM) at the completion of casting and one month after discontinuation, and number of complications due to casting procedure. Results: No differences in ROM improvement between duration groups ( F = 0.43, p = 0.51) and GCS groups ( F = 1.3, p = 0.26) were observed. Complications in serial casting were found in 25.0% in group A, in 10.6% in group B (chi-squared = 4.2, p = 0.042), in 24.5% in group 1, and in 8.3% in group 2 (chi-squared = 6.0, p = 0.014). Conclusion: This study suggests that serial casting in patients with longer illness duration and higher levels of consciousness provides improvements in ROM comparable with an earlier treatment in patients with more impaired consciousness, but results in a lower occurrence of complications.