Long Arm Serial Casting Results in Decreased Spasticity and Improved Function for Woman with Multiple Sclerosis

Abstract

<h3>Research Objectives</h3> To evaluate if LASC would decrease upper extremity spasticity and improve function in a 52 y.o woman with Relapsing Remitting MS. <h3>Design</h3> This study was a single-patient case study. <h3>Setting</h3> All sessions were completed at the Andrew C. Carlos Multiple Sclerosis Institute at Shepherd Center. <h3>Participants</h3> The participant was a 52 y.o female diagnosed with relapsing remitting MS in 2009. She presented with nonfunctional use, the inability to use her extremity effectively to complete activities of daily living (ADLs)/instrumental activities of daily living (IADLs), of her right upper extremity (RUE) and an intact left upper extremity (LUE). <h3>Interventions</h3> All interventions of the right upper extremity (RUE) were performed by a licensed occupational therapist. Serial casting involves a series of casts which are applied and removed with the goal of increasing range of motion (ROM) with each cast. The final LASC is then turned into a bivalve cast by cutting it in half to allow for daily application and removal. Intervention totaled 9 weeks or 9 treatment sessions after 8 sessions of conservative measures were found to be ineffective: Week 1/session 9 consultation/education for LASC, weeks 2 and 3/sessions 10-12 LASC and bivalve fabrication, and weeks 4-9/sessions 13-17 continued use of bivalve in combination with neuromuscular re-education, strengthening and functional training. <h3>Main Outcome Measures</h3> Modified Tardieu, Modified Ashworth Scale (MAS), pain, strength, skin, ROM, and function were assessed. <h3>Results</h3> Modified Tardieu and MAS improved. Increased strength occurred in shoulder flexion, elbow flexion/extension and supination. Active shoulder range of motion, not possible pre-intervention due to pain, was pain free post-intervention for abduction, horizontal abduction, horizontal adduction and external rotation. Furthermore, increased functional use including feeding, dressing, and bathing was achieved. <h3>Conclusions</h3> Long arm serial casting may be an effective intervention for individuals with MS who have debilitating upper extremity spasticity. To the writer's knowledge, there is no published research regarding LASC for individuals with MS. Additional research is warranted. <h3>Author(s) Disclosures</h3> No known disclosures at this time.