Factors Predictive of Equinus Deformity Relapse and Subsequent Need for Repeated Casting in Children with Cerebral Palsy

Brooke Gebhart, SPT, Hannah Klinkhammer, SPT, and Tanner Munk, SPT

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18 Comments on “Factors Predictive of Equinus Deformity Relapse and Subsequent Need for Repeated Casting in Children with Cerebral Palsy

  1. Is equines deformity common in children with CP, or are there any other diseases/syndrome? Are there other methods aside from serial casting for deformity correction that have been tested in children with CP?

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    • Equinus deformity is quite common in children with CP as cerebral palsy is damage to the pyramidal or extrapyramidal tract (UMN lesion) which consistently results in cerebral palsy. But equinus is not guaranteed in children with CP. Other treatment options include botox injections and surgical tendon lengthening.

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  2. Although you did not find significant results between repeated casting and one-time casting, what would you recommend to a parent/guardian if they were asking about options for casting treatment?

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    • We found that overall casting is an effective treatment that can make significant changes in a child’s range of motion. We would likely discuss the importance of a multi-disciplinary approach, incorporating physical therapy and medications as well.

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  3. Is repeated casting the go to treatment or are there more conservative options parents/guardians could try first?

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    • Good question, Brett. Many sources discuss the use of AFOs and therapeutic stretching. As this is a non-surgical technique, it is still viewed as conservative, though. One of our biggest takeaways from this research was the effectiveness of serial casting. Additionally, the children were checked for adverse reactions to the casting each week and the treatment was discontinued if there was any reaction or breakdown.

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  4. Great poster! It’s very easy to read and follow the course of your research. So since the management of spasticity is largely variable and influences the needs for repeated casting, were there any differences among the 5 children that were taking medications and the remainder of the subjects? Also, what did the “treatment within the years of 2012-2018” consist of – was that just the time frame of casting or were they receiving additional services from other resources? Thanks guys!

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    • Thank you Avery! The timeline of 2012-2018 was as far back as the data archives went, so we could not pull any data preceding 2012. There was also no documentation of other prior or concurrent treatments the children were receiving. For the 5 children taking medications, no statistical significance in change was observed.

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    • Thank you, Avery. Unfortunately, we did not have a lot of information on the medications the children were taking. With a retrospective chart review, we were at the mercy of the information collected at the initial evaluation; many of the children’s charts did not list any medications. Those taking medications included, baclofen, diazepam, and clonidine. There was not enough information to compare these cases or draw any conclusions, though. In 2012, the clinics we used for our data collection switched to the present electronic charting system, so we only had information from then until the start of our research project.

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  5. What was the difference between the limbs to be classified as them having a leg length discrepancy?

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    • Great question, Aaron. I am interested as well what constitutes a leg length discrepancy, clinically. Beings this was a retrospective chart review we were unable to gather measurements. Leg Length discrepancy was a ‘yes’ or ‘no’ item that was collected off our participants chart.

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  6. Very interesting poster! One question I have for you is, what are some adverse reactions to casting, and how might they differ from single casting vs serial casting? Also, do you think leg length discrepancy is significant to equinus deformity in children with CP?

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    • Thank you! Skin breakdown with not only serial casting, but a single cast episode is of concern. Additionally, skin irritation to specific casting protocol (plaster, fiberglass, or mixed plaster/fiberglass) could lead to further skin breakdown/infection. Muscle atrophy, while casted is another adverse ‘reaction’. I would imagine serial casting, beings this is a form of treatment with multiple removal and re-application procedures, may increase risk of these and other adverse events in comparison to a single cast episode. Overall casting tolerance was a variable that was pulled for our chart review. This was more to describe (“none, minor, major” per physician documentation) a patients skin integrity following removal of a cast.

      #2 I do think leg length discrepancy (LLD) would be a significant variable in determining repeat casting episodes if the child presented with a LLD prior to casting. This ultimately meaning that the serial casting was unsuccessful initially, or the child had a relapse with their equinus deformity. Does this answer your question?

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  7. This is an interesting topic of study and a very informative poster! I was wondering if there was an observable trend in for a prime smaller age range where serial casting is more prevalent within your range of 2.25 years and 28.75 years?

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    • Thanks Alyssa! 28.75 years old was certainly an outlier, and seems like an odd age to begin serial casting. To your question- yes! Most of our subjects were between the age range of ~ 4-10. A very select few were > than 15 years old. Beings we were limited to participants, it was necessary we include these charts.

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  8. Hey guys! Hope clinical sites are going well – have any of you guys had a chance to see serial casting on anyone through your clinical sites? Or maybe had any kiddos with a history of it being done? Anyway, just want to know if you had any exposure to it in the clinic!

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    • I have to not seen any children with serial casting yet. I am currently in a school-based setting now, but none of our current children have cerebral palsy. I am hoping that with my hospital-based pediatric rotation next semester I will be able to see serial casting. Hope you are enjoying your clinical rotation!

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