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The Use of Casts in the Management of Joint Mobility and Hypertonia Following Brain Injury in Adults: A Systematic Review

PA Mortenson, BScOT, is Occupational Therapist, Children's and Women's Health Centre, Vancouver, British Columbia, Canada, and Graduate Student, School of Rehabilitation Sciences, University of British Columbia, Vancouver
JJ Eng, PT/OT, PhD, is Associate Professor, School of Rehabilitation Sciences, T325-2211 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 2B5 (janicee{at}interchange.ubc.ca), and Scientist, Rehabilitation Research Laboratory, GF Strong Rehab Centre

Address all correspondence to Dr Eng

Many controversies exist regarding the practicality, the theoretical premises, and the supporting evidence for the use of casts in the management of joint hypomobility and hypertonia (ie, increase in joint resistance to passive movement resulting from hyperactivity of the stretch reflex and/or changes in the muscles and connective tissues). The purpose of this review was to determine current best practice for the use of casting in the rehabilitation of adults with brain injury. A systematic review was undertaken to find studies that quantified the effectiveness of casting in adults with brain injury. Thirteen articles that presented experimental or case report evidence on casting were analyzed using Sackett's levels of evidence and were examined for scientific rigor. A grade B recommendation is given for the use of casting to increase passive range of motion or to prevent its loss, and implications for further research are provided.

Key Words: Brain Injury • Casting • Muscle spasticity • Rehabilitation

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