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An Integrated Team Approach for Serial Casting/Orthotic Intervention/Physical Therapy (AM2024-OS02)
2024 Annual Meeting Education Content
Keyword(s)
#AM2024, Annual Meeting, Casting, Orthotics, Physical Therapy, OS02
Learning Objectives:
- Attendees will learn the role of child development in toe walking. Attendees will develop an understanding of the importance of the relationship between the Center of Mass and the Base of Support in addressing the causes of toe walking. Attendees will learn the importance of gaining foot alignment as the first goal for serial casting. Attendees will learn day and stretch AFO designs that maintain serial casting gains. Attendees will learn that Serial Casting can make substantial improvements which can endure with Orthotic and PT Follow Up. Attendees will learn that talocrural dorsiflexion end ranges should be based on many factors including: the child’s age, severity of deformity within the ankle and foot, the amount of stiffness and the fluidity of passive range of motion. Attendees will learn that casting and orthotic management can maintain ranges until the child has had skilled therapy to address their postural deficits. Attendees will understand the length of casting is determined by the child and not a predetermined number of weeks.
- Attendees will develop an understanding of the importance of the relationship between the Center of Mass and the Base of Support in addressing the causes of toe walking. Attendees will learn the importance of gaining foot alignment as the first goal for serial casting. Attendees will learn day and stretch AFO designs that maintain serial casting gains. Attendees will learn that Serial Casting can make substantial improvements which can endure with Orthotic and PT Follow Up. Attendees will learn that talocrural dorsiflexion end ranges should be based on many factors including: the child’s age, severity of deformity within the ankle and foot, the amount of stiffness and the fluidity of passive range of motion. Attendees will learn that casting and orthotic management can maintain ranges until the child has had skilled therapy to address their postural deficits. Attendees will understand the length of casting is determined by the child and not a predetermined number of weeks.
- Attendees will learn the importance of gaining foot alignment as the first goal for serial casting. Attendees will learn day and stretch AFO designs that maintain serial casting gains. Attendees will learn that Serial Casting can make substantial improvements which can endure with Orthotic and PT Follow Up. Attendees will learn that talocrural dorsiflexion end ranges should be based on many factors including: the child’s age, severity of deformity within the ankle and foot, the amount of stiffness and the fluidity of passive range of motion. Attendees will learn that casting and orthotic management can maintain ranges until the child has had skilled therapy to address their postural deficits. Attendees will understand the length of casting is determined by the child and not a predetermined number of weeks.
Credit Information
1.75 CEUs for Certified Orthotists, Certified Pedorthists
Author(s)
Donald McGovern, CPO, FAAOP, Shari Cassidy, PT, Gila Baer, MPO, CP, Haley Ashley DPT, Tara Wright, MSOP, CPO, LPO, FAAOP
Description
Serial casting is a frequently used medium for gaining Range of Motion of stiff joints. This serial casting/orthotic/PT team has worked together for several years with beneficial results.
The persons in the program represent the pediatric population with a variety of diagnoses, including but not limited, Muscular Dystrophy, Idiopathic Toe Walking, Autism, Myelomeningocele, and Cerebral Palsy.
This serial casting program length is dictated by very specific goals – and can last from weeks to months. These goals include addressing tarsal, metatarsal and metatarsal phalangeal positioning to gain an optimal boney alignment and ROM gain of R1 and R2. Each cast is aligned optimally per the Owen guidelines.
Orthotic intervention is an integral part of the protocol. Each serial casting is followed with a Solid Ankle Foot Orthosis for day use and a stretch AFO. The day use SAFOFCs are in generally in 3-5*DF. Specific static stretch AFOs generally in 20* DF. AFO stiffness of the AFO material, trim lines, and reinforcement is considered per individual presentation. Wear is expected to last 23 hours per day for the next year.
Physical Therapy continues the Serial Casting Protocol upon fit and delivery of the AFOs.
This protocol routinely achieves dorsiflexion R2 ankle angles of ~ 20* in subtalar neutral with the knee extended. R1 minimally achieves 3-5*DF in subtalar neutral with knee extended – often 10* is achieved. The great majority of cases do not require repeat casting in the years to come.
The persons in the program represent the pediatric population with a variety of diagnoses, including but not limited, Muscular Dystrophy, Idiopathic Toe Walking, Autism, Myelomeningocele, and Cerebral Palsy.
This serial casting program length is dictated by very specific goals – and can last from weeks to months. These goals include addressing tarsal, metatarsal and metatarsal phalangeal positioning to gain an optimal boney alignment and ROM gain of R1 and R2. Each cast is aligned optimally per the Owen guidelines.
Orthotic intervention is an integral part of the protocol. Each serial casting is followed with a Solid Ankle Foot Orthosis for day use and a stretch AFO. The day use SAFOFCs are in generally in 3-5*DF. Specific static stretch AFOs generally in 20* DF. AFO stiffness of the AFO material, trim lines, and reinforcement is considered per individual presentation. Wear is expected to last 23 hours per day for the next year.
Physical Therapy continues the Serial Casting Protocol upon fit and delivery of the AFOs.
This protocol routinely achieves dorsiflexion R2 ankle angles of ~ 20* in subtalar neutral with the knee extended. R1 minimally achieves 3-5*DF in subtalar neutral with knee extended – often 10* is achieved. The great majority of cases do not require repeat casting in the years to come.