title: The influence of illness duration and level of consciousness on the treatment effect and complication rate of serial casting in patients with severe cerebral spasticity.
abstract: OBJECTIVE
  To compare the improvement and complication rates for serial casting in patients with shorter as opposed to longer illness duration, and in patients with lower as opposed to higher levels of consciousness.
  
  
  METHODS
  A retrospective case-comparison study.
  
  
  METHODS
  A rehabilitation centre for adult persons with neurological disorders.
  
  
  METHODS
  Sixty-eight patients with cerebral spasticity of different aetiologies were treated with serial casting to relieve fixed contractures.
  
  
  METHODS
  Serial casting with either < 90 days (group A, 36 joints, 24 patients) or > or = 90 days (group B, 85 joints, 44 patients) duration of illness and either < 12 (group 1, 49 joints, 25 patients) or > or = 12 (group 2, 72 joints, 43 patients) Glasgow Coma Scale (GCS) scores.
  
  
  METHODS
  Percentage of normal maximum range of motion (ROM) at the completion of casting and one month after discontinuation, and number of complications due to casting procedure.
  
  
  RESULTS
  No differences in ROM improvement between duration groups (F = 0.43, p = 0.51) and GCS groups (F = 1.3, p = 0.26) were observed. Complications in serial casting were found in 25.0% in group A, in 10.6% in group B (chi-squared = 4.2, p = 0.042), in 24.5% in group 1, and in 8.3% in group 2 (chi-squared = 6.0, p = 0.014).
  
  
  CONCLUSIONS
  This study suggests that serial casting in patients with longer illness duration and higher levels of consciousness provides improvements in ROM comparable with an earlier treatment in patients with more impaired consciousness, but results in a lower occurrence of complications.
authors.affiliation: Department of Neurological Rehabilitation, Klinik Bavaria, An der Wolfsschlucht 1-2, D-01731 Kreischa, Germany. pohl@klinik-bavaria.de
authors.forename: Marcus
authors.initials: M
authors.lastname: Pohl
authors.forename: Jan
authors.initials: J
authors.lastname: Mehrholz
authors.forename: Stefan
authors.initials: S
authors.lastname: Rückriem
mesh_terms: D001930:Brain Injuries / Q000150:complications*; D005260:Female; D006801:Humans; D007103:Immobilization; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology* / Q000534:rehabilitation*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome