Date Presented 04/21/2023

Upper extremity serial casting should be considered a beneficial nonsurgical treatment approach to address range of motion (ROM) limitations in children with cerebral palsy (CP) especially resulting from the negative effects caused by the COVID-19 pandemic.

Primary Author and Speaker: Alicia Hana Heisler

Serial casting is a commonly used intervention for spasticity related deformities in lower extremities of children with CP (Dursun at al., 2021). Historically there has been a limited amount of research on upper extremity serial casting. The recent COVID-19 pandemic had a prominent negative effect on patients with CP due to lack of rehabilitation and orthotic support during lockdown restrictions (Bhaskar, Gad & Rathod, 2022; Cankurtaran et al., 2021). This experimental study aims to assess upper extremity serial casting and seek to determine if this approach is deemed a beneficial non-surgical treatment option to gain ROM and improve orthotic wear in children with CP. Participants were ages 7-20 years with upper extremity spasticity and joint range limitation impacting orthoses tolerance. They were referred to OT for serial casting by the PM&R medical team at MCWHLB. Each participant also received a form of medical spasticity management. The subjects (n=8) were seen for casting to improve elbow, wrist or finger extension. Reapplication of cast was completed weekly. Casting was discontinued once ROM gains measured less than 3 degrees. The total amount of sessions per subject ranged from 2 to 10. Results of this study revealed ROM improvements for targeted joints in all subjects following intervention. Each participant was then fit into a splint/orthosis to maintain new ROM. Serial casting should be considered a beneficial non-surgical treatment approach to address upper extremity ROM limitations in children with CP. Occupational therapists can help remedy negative impacts the COVID-19 lockdown had on this population by implementing serial casting to address loss of ROM leading to limited use of bracing. It would be beneficial to the field of occupational therapy to continue to analyze the benefits of serial casting for upper extremities as literature does support this approach but historically only a limited amount of studies have been published.


Bhaskar, A., Gad, M., & Rathod, CM. (2022). Impact of COVID pandemic on the children with cerebral palsy. Indian Journal of Orthopaedics, 56, 927–932.

Cankurtaran, D., Tezel, N., Yıldız, S., Celik, G., & Unlu Akyuz, E. (2021). Evaluation of the effects of the COVID-19 pandemic on children with cerebral palsy, caregivers’ quality of life and caregivers’ fear of COVID-19 with telemedicine. Irish Journal of Medical Science, 190(4), 1473–1480.

Dursun, N., Gokbel, T., Akarsu, M., Bonikowski, M., Pyrzanowska, W., & Dursun, E. (2021). Intermittent serial casting for wrist flexion deformity in children with spastic cerebral palsy: a randomized controlled trial. Developmental Medicine & Child Neurology, 63(6), 743–747.

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