Upper extremity inhibitive casting in a boy with spastic quadriplegia.

552 O ccupational and physical therapists are often concerned with maintaining joint range of motion in children with neurological impairment. The presence of spastic posturing may be a serious problem that limits activities of daily living and qual ity of movement. Traditional therapy techniques include passive range of motion exercises, active exercises, positioning, and neurodevelopmental treatment to inhibit abnormal tone and movement. Daily stretching and range of motion exercises can be painful, however, which in turn increases the child's overall body tone and results in a time-consuming, ineffective form of treatment. For over a decade, serial and plaster dropout casts have been used effectively to manage spasticity in adults with head injury and in children with neurological impairment (Cherry & Weigard, 1981). In a study of 42 adults with head injury at Rancho Los Amigos Hospital, Downey, California, progressive serial casting was used for the effective management of both upper and lower extremity deformities resulting from spasticity (Booth, Doyle, & Montgomery, 1983). King (1982), in describing the use of plaster dropout splints to reduce elbow flexor spasticity, suggested that the effectiveness of such splints is a result of "the autogenic inhibitory response of the 1b afferent fibers serving the golgi tendon organs" (p. 671). King also suggested that the splints may proVide warmth, which could further reduce spasticity. A case study completed at the Children's Clinic and Preschool in Seattle examined the effects of upper extremity casting in a 5Y2-year-old child with spastic quadriplegia (Smith & Harris, 1985). The study showed that the casts were effective in maintaining extension and in preventing further increases in elbow flexion contractures. As a result of the increased elbow extension and stability proVided by the casts, improvements were noted in both the handling and positioning of the child. The present paper describes the effects of upper extremity casting in an older, more severely impaired child with spastic quadriplegia and provides gUidelines for cast fabrication. Initial casts were fabricated of plaster and were similar to those used by Smith and Harris (1985). Additional casts were made of fiberglass, and the use of hand splints was attempted.