Physical Therapy Management of Bilateral Knee Contractures Using Serial Casting in a Medically-Complex Rehabilitation Patient: A Case Report

Background: Serial casting is a technique that is used to improve muscle length and increase range of motion in joints that are limited by contractures. While it is typically utilized in pediatric populations including but not limited to cerebral palsy, club foot, and idiopathic toe walking, serial casting can also be used to treat adults with brain injury, spinal cord injury, and stroke. The purpose of this case report is to highlight the use of serial casting as part of a comprehensive rehabilitation process to treat a medically-complex adult. Case Description: Patient A was a 50-year old male who was admitted to inpatient rehabilitation following a series of multifaceted medical events. His diagnoses included both neurological and orthopedic components, including a brain injury, spinal cord involvement, and a total hip arthroplasty. Intervention: Patient A was seen by a physical therapist for 30-60 minutes, five days per week for six-and-a-half months. During this extensive rehabilitation period, the patient was treated with a variety of interventions, including serial casting. The primary goal of serial casting was to increase his bilateral knee range of motion (ROM) to improve his ability to perform functional activities, including walking and negotiating stairs. Outcome Measures: The outcome measures used to monitor progress included measuring range of motion, the 6 Minute Walk Test (6MWT), the Timed Up and Go (TUG), and the Modified Ashworth Scale. Discussion: The serial casting intervention was performed unilaterally with the goal of increasing the patient’s ability to participate in therapy and functional activities. We found that the patient improved knee extension ROM bilaterally even though only one leg was casted using this technique, suggesting that stretching and positioning alone also likely significantly influence ROM.