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:
- Cerebral palsy
- Idiopathic toe walkers
- Metatarsus adductus (an inward turned forefoot)
- Muscular dystrophy
- Peripheral neuropathy
- Spina bifida
- Spinal cord injuries
- Traumatic brain injury
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.
- Casts for lower extremities are applied by a licensed rehabilitation technician and a physical therapist.
- Casts for upper extremities are applied by a licensed rehabilitation technician and an occupational therapist.
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.
Casting is Tailored to Your Child
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.
What to Expect
What to Expect
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.
What to Bring
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:
- Keep it dry. Skin can blister or become irritated if the cast gets wet. Waterproof socks may keep the cast dry while bathing. Wrapping the cast in layers of plastic or shrink wrap and covering those layers with a plastic bag, followed by another layer of wrap protects the cast from moisture while bathing. The cast should never be immersed in water, but your child may take a quick shower, a sponge bath or leave the extremity outside the tub.
- Protect the cast during activity. Keep it covered with a sock to prevent dirt from getting inside the cast.
- Expect itching. There is no practical way to prevent itching, which stems from the skin not shedding normally and heat and moisture inside the cast. Keeping the body part cool and dry may be your best bet. Avoid scratching it by sticking objects inside the cast, which can damage a cast.
- Follow through with therapy. Make sure your child stays in physical therapy while he/she is in the cast. Remaining faithful to it afterwards can make a big difference for your child. A cast is not a standalone treatment; it is done to gain range of motion so your child can work on other goals for physical therapy, such as strength and balance. You can support your child’s treatment by doing prescribed exercises at home.
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.
Key Points to Remember
Key Points to Remember
- Serial casting is an established treatment for children who have rigid or spastic muscle tone.
- 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.
- Serial casting reduces tone, increases range of motion and gives children a smoother gait or better control of their hands.
- The duration and number of casts is very dependent on each child’s condition.
- Maintaining your child’s physical therapy and exercise routine at home can influence how much benefit serial casting offers your child.
- The advantage of serial casting at Riley at IU Health is access to a multidisciplinary team that works together for your child’s benefit.
Support Services & Resources
Support Services & Resources
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.