How are the casts removed? Helpful hints Serial …

1 Hamilton Health Sciences, 2005 PD 5341 - 08/2005 WPC\PtEd\CH\ dt/August 10, 2005 Serial casting How are the casts removed ? Removing a cast is not painful. An electric cast saw is used. The blade of the saw does not rotate; it vibrates. The saw will go through the rigid cast , but will not go through the soft padding underneath. However, since the saw is large and noisy, your child may be frightened by it and may need to be comforted. We have ear and eye protection available for you and your child to use. Helpful hints Children sometimes find the appointments long. Having a favorite activity for your child, such as books, colouring or music, may help. Your child can pick the colour of the cast .

2 Talking about the colour before the appointment may be fun for your child. At the end of the first appointment, we will fit a running shoe over each ankle cast . The orthotist will adapt the shoe to fit the cast and allow your child to stand and walk in it. Your child should wear this running shoe both indoors and outdoors for the entire time the casts are on. Each week the running shoe will be adjusted to allow your child to stand and walk on it. Standing and walking in casts speeds up muscle lengthening. If you have a pair of old shoes that you want your child to wear while the casts are on, we may be able to use them. We cut the front out of them so you will not be able to use them again for regular use.

3 The more your child s knees are straight while ankle Serial casts are on, the better. Your child should wear gaitors or knee-immobilizers while sleeping to help keep his or her knees straight. This will speed up the process of stretching the muscles behind the ankles. After Serial casting is finished, a splint or brace is often used to help keep the gains made by casting . Talk to your therapist about a wearing schedule for the brace after the casting is finished. If you have any questions, call the hospital at 905-521-2100: Orthotist: _____ Phone: _____ Therapist:_____ Phone: _____ Serial casting This information sheet answers some common questions about Serial casting .

4 Your orthotist and therapist will give you more information about how Serial casting can help your child. You will need to consider the risks and benefits of Serial casting and any alternative treatments. If you have any questions, please ask your child s orthotist or therapist. If you decide that your child will have Serial casting , you will be asked to sign a consent form. Your signature on this form gives the orthotist permission to go ahead with the procedure. What is Serial casting ? Serial casting is the process of applying and removing a series of lightweight, fiberglass casts on an arm or leg. Every 1 to 2 weeks, the angle of the cast is changed to slightly stretch the muscles and move the joint a little closer to the correct position.

5 This can be done in one of 2 ways: removing the entire cast and replacing it with a new cast , or wedging - cutting out a section of the cast to change the angle and re-wrapping it Over time, Serial casting can make muscles grow longer and improve the movement of a joint. The orthotist and therapist, with your input, decide how many casts your child will need and how often to change the casts . Four to six Serial casting sessions are usually needed. Serial casting Serial casting please turn over How could Serial casting benefit my child? If your child has a contracture, the muscles, ligaments and tendons in his or her arm or leg are tight and the joint has limited movement. This may be due to increased muscle tone, called spasticity, or because your child is not able to move normally.

6 Serial casting can help relieve some types of contractures. Serial casting may help your child use his or her arm or leg better, or be able to fit and wear a brace or splint more comfortably. Is Serial casting painful? The stretch from Serial casting is very slow and gradual, so Serial casting should not be painful. If your child has pain while the cast is on, please tell your orthotist. How do I care for my child s cast ? The cast is not waterproof. You must keep the cast dry. If you like, you can cover the cast with a large stretchy sock, and cover it in plastic if there is a chance of the cast getting wet (for example, when walking outside). When bathing, you must not allow the cast to touch the water.

7 This may mean that your child will need to have a sponge bath while the casts are on. Sometimes, parents can put the cast on a plastic stool inside the tub with the cast well wrapped in plastic and towels (just in case it gets splashed). Do not immerse the cast in water. Make sure that your child does not use any sharp objects, such as knitting needles or sticks or pens, to scratch under the cast . If itchiness is a problem, blow cool air into the cast using a hair dryer. Be sure the setting is on cool! Do not stuff any extra padding under the edges of the cast . Too much padding can restrict blood flow to the limb. Avoid getting crumbs, sand, coins, food or small toys under the cast . A damp cotton swab will allow you to clean around the toes or fingers.

8 What are the possible side effects for Serial casting ? Check your child s arm or leg and cast often. Some possible side effects of the casts are not urgent, including: dry or itchy skin skin rash or blisters weak muscles, joint pain or stiffness after the cast is removed your child may not sleep as well When do I need to get medical help right away? Some problems are serious and your child s cast may need to be removed right away. If you have any of the following problems, call your child s orthotist: blue, cold or very swollen fingers or toes the cast feels tight your child has pain or a painful muscle spasm in the casted arm or leg that does not go away in a few hours your child has very disturbed sleep your child s arm or leg feels numb, or has a tingling, pins and needles or asleep feeling your child is unable to move his or her fingers or toes as usual your child cannot bear weight on the casted foot the cast smells very bad the cast becomes wet, soft or cracked an object becomes stuck under the cast If you are not able to reach the orthotist, take your child to the nearest hospital emergency room.

9 Serial casting Serial casting please turn over How could Serial casting benefit my child? If your child has a contracture, the muscles, ligaments and tendons in his or her arm or leg are tight and the joint has limited movement. This may be due to increased muscle tone, called spasticity, or because your child is not able to move normally. Serial casting can help relieve some types of contractures. Serial casting may help your child use his or her arm or leg better, or be able to fit and wear a brace or splint more comfortably. Is Serial casting painful? The stretch from Serial casting is very slow and gradual, so Serial casting should not be painful. If your child has pain while the cast is on, please tell your orthotist.

10 How do I care for my child s cast ? The cast is not waterproof. You must keep the cast dry. If you like, you can cover the cast with a large stretchy sock, and cover it in plastic if there is a chance of the cast getting wet (for example, when walking outside). When bathing, you must not allow the cast to touch the water. This may mean that your child will need to have a sponge bath while the casts are on. Sometimes, parents can put the cast on a plastic stool inside the tub with the cast well wrapped in plastic and towels (just in case it gets splashed). Do not immerse the cast in water. Make sure that your child does not use any sharp objects, such as knitting needles or sticks or pens, to scratch under the cast .