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Table 1 casting and rigid orthoses

From: Why orthotic devices could be of help in the management of Movement Disorders in the young

Type of publication Aims and summary Approach and Sample size Conclusions Ref.
Scientific paper Studying the effect of intensive neurodevelopmental therapy (NDT) and upper-extremity inhibitive casting, separately or in combination, on hand function, quality of upper-extremity movement and range of motion. Clinical study.
Comparison of two different intensities of NDT with and without bivalved casts.
73 children with cerebral palsy.
Age: 18 months to 8 years
There was no significant difference between intensive or regular therapy and casting or no casting for hand function, between intensive and regular NDT, or between intensive NDT plus casting and the other groups for quality of movement and range of motion. Casting led to increased quality of movement and wrist extension after 6 months. Casting with NDT improved the quality of upper-extremity movement and range of motion. There appear to be no immediate benefits from intensive therapy alone. [70]
Scientific paper Studying the effect of neurodevelopmental therapy (NDT) and upper-extremity inhibitive casting, separately or in combination, with occupational therapy (OT), on hand function. Clinical study.
Cross-over trial between intensive NDT with casting, and OT.
50 children with cerebral palsy.
Age: 18 months to 4 years
Analysis of the outcomes revealed no significant differences in hand function, quality of upper-extremity movement, or parents’ perception of hand-function performance between the two treatment groups. There does not appear to be any beneficial effect of an increased amount of therapy for the children in this study. [71]
Scientific review Reviewing the treatment of hyperkinetic movement disorders. In describing different approaches to the treatment of various movement disorders, the paper includes a statement about casting for dystonia. Review of the literature. Immobilisation can actually exacerbate or even precipitate dystonia, as is the case in peripherally induced dystonia. [1]
Book chapter Describing different devices employed especially to avoid deformities, block the function, and prevent the beginning of the chain created as a functional pattern. Summary of rehabilitation strategies for dystonia in children. Traditional splints or rigid orthoses, made of relatively thick thermoplastic, can provide rigidity, position and stretch the muscles in patients with increased muscle tone. To provide some positive effects, the devices should be designed for each patient, due to the particular needs required by every clinical picture. [19]
Scientific review Reviewing the evidence on the effectiveness of using upper and lower limb casting or orthoses in children with cerebral palsy. Review of the literature. Further investigation are needed to prove some positive effects, the devices should be designed for each patient, due to the particular needs required by every clinical picture. [20]
Scientific paper Evaluating modification in writing ability by immobilisation in patients with hand dystonia. Static hand orthosis was used to support and immobilise the segments of the hand interfering with writing (thumb, fingers, or wrist), and allowing the proximal large muscles to control the writing movements (Fig. 1). Clinical single-cases study.
5 adults patients affected by hand dystonia.
Age: 35 to 59 years old.
Results demonstrated an improvement in writing ability of patients while using the hand orthosis. Authors recommend the application of the hand orthosis in association with other therapies to overcome a disability that handicaps the patient’s daily life and vocation. [69]
Scientific paper Evaluating the combined use of an orthosis and occupational therapy.
An elbow immobiliser has been prescribed during the application of an occupational therapy programme, to modify the hand function in children with athetoid CP. The device restricted the unwanted movement around the proximal joints (shoulder and elbow joints).
Clinical study.
40 children with athetoid cerebral palsy.
Age: 6.51 ± 0.97 years.
Wearing the elbow immobiliser during the application of occupational therapy program has a potential benefits to improve the hand function athetoid CP patients, through controlling the involuntary movement and allowing good performance during fine motor training for longer time and in an effective way. The significant improvement noticed in hand function in the study group vs. controls (that only did the occupational routine) may be due to reduced distal involuntary movement obtained by wearing the elbow immobiliser during training of fine motor skills. [46]
Scientific paper Evaluation of a hand splint.
Therapy involved immobilisation by splint(s) of 1+ of the digits other than the focal dystonic finger and Repetitive exercises in coordination with 1+ of the other digits.
Clinical single-cases study.
5 adults patients affected by focal hand dystonia.
Immobilising the unaffected limb can help exercise more the impaired limb Positive results in 3 out of 5 musicians with focal hand dystonia after such kind of therapy. [72]
Scientific review Reviewing the effects of constraint-induced therapy. Constraint-induced movement therapy has been applied during the rehabilitation of patients with spasticity after stroke to limit non-dystonic segments and to exercise the affected ones. Review of the literature. Unclear benefit using constraint-induced therapy, in the treatment of dystonia. [1]
Scientific paper Evaluating the effect of movement restriction in cerebral palsy. The research hypothesis was that restriction of the less-involved hand with a resting splint would result in increased use of the more-involved hand in a child with spastic cerebral palsy. Clinical single-cases study.
One 2-year-old girl with greater involvement of the right side.
An improvement in quality, quantity, and variety of use of the more-involved extremity after splinting, with some continuing improvement. Results for a single-case; necessity to enlarge the population tested. [73]
Systematic review Describing systematically the best available intervention evidence for children with cerebral palsy (CP). Systematic review of systematic reviews. The lack of certain efficacy evidence for large proportions of the interventions in use within standard care is a problem for people with CP, healthcare providers, purchasers of healthcare and funders. More research using rigorous designs is urgently needed as CP is the most common physical disability of childhood with a life-long impact. [17]
Review article Investigating treatments and current evidence to improve upper limb outcomes and goal attainment. Review of the literature. Some results have been obtained on larger cohort of patients even if affected by mainly spastic forms. [74]
Scientific paper Evaluating the effect of segment immobilisation on motor scheme recovery. Casting or immobilisation by an orthosis has been suggested also as a treatment aiming to deprive the dystonic segments of motion and sensation, which could help patients reset lost motor schemes. Clinical study.
8 patients with idiopathic occupational focal dystonia of the upper limb, the dystonic forearm and hand were immobilised with a plastic splint.
Limb immobilisation can be a simple, effective, safe, and inexpensive treatment for focal occupational upper-limb dystonia. [45]