Update on Therapeutic Casting: A Modern Clinical Pathway to Improve Outcomes
Section: Academy of Pediatric PT
Session Code: PD-P2-6116
Date: Wednesday, January 23, 2019
Time: 8:00 AM - 5:00 PM
Location: Marriott Marquis
Room: Independence Salon D
Registration Fee Required: 1B
Session Type: Preconference Courses
Session Level: Intermediate
Dorsiflexion restriction is a key impairment which contributes to activity limitations for children and adults with health conditions impacting the neurological and muscular systems. Serial casting has been shown to be effective in addressing this restriction, traditionally focusing on increasing muscle length through prolonged application of passive range of motion. However, the ankle is a complex, multi-joint system prone to impairments and anatomical variants even in the absence of neurological impairment. Among patients with a given diagnosis, there may be a wide range of contributing drivers, limiting structures, and compensations. Modern materials have advanced the complexity of forces that can be applied using a cast to address specific restrictions. This course will propose a framework for therapeutic casting using a clinical reasoning guide which considers the complexity of the system and heterogeneity of patient presentations. Participants will perform differential diagnosis for primary and secondary structures contributing to motion limitations and address soft tissue and joint restrictions while using techniques to decrease tonic muscle contractions and patient stress. Therapists will then apply casts, selecting among various techniques and materials based on the needs of the movement system of each patient. Finally, casts will be aligned to optimize therapeutic gait. The course will include labs to apply practical skills for clinical use after completion.
Learning Objectives: Upon completion of this course, you will be able to:
1. Select candidates for therapeutic casting using the ICF model.
2. Differentiate contributing factors influencing restricted range of motion at the ankle, including structural alignment, ground reaction forces, muscular pull, joint and soft tissue mobility, and directional susceptibility to movement.
3. Apply a therapeutic cast with efficient body mechanics, selecting among casting techniques and materials based on patient presentation to direct forces to target structures and protect compromised tissues.
4. Design casts to maximize therapeutic gait, using strategies to impact gait kinematics and kinetics with ground reaction force.
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