Many children come to Riley at IU Health to seek care for health conditions that lead to rigid muscles, contractures and restricted range of motion. Our multidisciplinary team can improve range of motion and soften muscles that are abnormally rigid or spastic by applying serial casts—an established treatment that benefits children with:
Whether serial casting occurs during a hospital stay or as an outpatient, it may help children walk better or improve fine motor skills that involve the hands or arms. Serial casts are done by a combination of professionals.
The procedure applies fiberglass cast over padding on a particular part of the body. The purpose of the cast is to stretch tight or shortened muscles. It is called serial casting because the position of the body changes each time a new cast is applied, gradually increasing the flexibility of the muscle with a series of casts applied over time. Most children come to serial casting through a referral from a physician, a physical therapist or an occupational therapist who believes it could help them function better.
Riley at IU Health physical therapists, physicians and orthotists work together to plan your child’s treatment and deliver the care necessary for a positive outcome. Our multidisciplinary team draws families from across Indiana, many of which lack local access to the combined skills found here.
Some children see our physical medicine rehabilitation physician and get a Botox® injection into affected muscles before serial casting—a combined treatment that has been very effective for reducing tone, increasing range of motion and giving children a smoother gait or better control of their hands.
Serial casting is a highly customized treatment that varies with every child. Each cast may stay on for up to seven days, and a new cast may be applied every week for three to 12 weeks. The duration often depends on your child’s condition and how diligent your family is about doing physical therapy and practicing certain exercises at home—key factors for success in serial casting.
Some children may have casting in one series and never need to return. Children with neurological disorders are more likely to need serial casting again at some point, although medication and continued physical therapy can help them maintain range of motion.
Casting begins by measuring your child’s muscle tone using a Modified Ashworth Scale and Tardieu Scale. These tools help us set treatment goals. Fiberglass casts are applied over a cotton barrier and padding to protect your child’s skin and prominent bones.
After the first cast goes on, your child wears it for a set length of time to maintain a static stretch. On your child’s next visit, we remove the cast, measure again and slightly increase the angle of the stretch in the new cast. Removing the cast is a painless procedure done with a special tool that vibrates.
This pattern repeats each week, following the treatment prescribed by your child’s team of therapists. Muscle tone gradually improves, becomes less spastic and children have a better range of motion in the affected body part.
If the feet are cast, your child may get special socks and shoes to wear. Children can resume most regular activities while the cast is on, but they should not bear weight for at least two hours after casting. This allows the cast to set.
Casts should not cause pain, but they can be awkward and heavy to carry around and may be uncomfortable for the first few days. If pain does occur, you should contact the therapist or physician who is following your child to determine a course of action, which may include cast removal.
Applying a cast may take up to an hour or double that when it is accompanied by a Botox® injection. Families can bring activities to keep their child entertained during casting.
We give children, parents and caregivers special instructions about how to care for a cast. Here are a few cast-care tips:
After serial casting, orthotics are often part of follow-up care to help your child maintain increased range of motion. Our orthotic specialists collaborate closely with each child’s family, physical therapist, occupational therapist and physician to support progress and help kids lead fuller, more active lives.
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
This website provides information to the public about physical therapy and wellness. It is supported by the American Physical Therapy Association, an organization that advances professional development and education for physical therapists.
Parents and caregivers can find tips on caring for casts at this website, which offers expert orthopedic information.