OBJECTIVES: This study compares casting to traditional techniques, such as passive range of motion, static stretch, and splinting, in the treatment of the hypertonic upper extremity in individuals with severe brain injury. METHOD: Fifteen subjects with brain injury were randomly assigned to one of two groups. One group received a month of casting followed by a month of traditional therapy; the second group received 1 month of traditional therapy followed by casting. The subjects' limbs were evaluated for range of motion, clinical indications of spasticity, and functional use of the extremity at three intervals -- before intervention, after the first month of intervention, and after the second month of intervention. Two sample t-tests and paired t-tests were used in data analysis. RESULTS: All but one subject showed a greater improvement in range of motion with casting than with traditional treatment; 11 subjects showed a greater improvement in clinical measures of spasticity with casting. There was no apparent correlation between these measures and functional use of the extremity. CONCLUSION: These findings suggest that casting is more effective than traditional techniques in reducing contracture and in decreasing hypertonicity in some cases. The greater improvements in these motor indicators with casting did not translate into greater gains in functional use of the upper extremities.
Copyright by the Amerrican Occupational Therapy Association Inc. Reprinted with permission.

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