Effectiveness of a programme comprising serial casting, botulinum toxin, splinting and motor training for contracture management: a randomized controlled trial.

[OBJECTIVE] To determine the effectiveness of a programme comprising serial casting, botulinum toxin, splinting and motor training in contracture management.

[DESIGN] A randomized trial with concealed allocation and assessor blinding, a deferred treatment cross-over design within the control group, was conducted.

[SETTING] Inpatient Brain Injury Unit of a rehabilitation centre.

[SUBJECTS] A total of 10 patients with severe acquired brain injury (13 ankles).

[INTERVENTIONS] The intervention group received botulinum toxin and then serial casting. The control group was placed on a wait list for six weeks (control phase) and then received the same interventions as the intervention group (intervention phase). Both groups received splinting and motor training following serial casting.

[MAIN MEASURES] The primary outcome was passive ankle dorsiflexion range. Secondary outcomes included spasticity, ankle dorsiflexor strength, Functional Independence Measure score for the walking item and walking speed.

[RESULTS] The mean between-group difference for passive ankle dorsiflexion range at completion of casting was 26° (95% confidence interval (CI): 17-35); at Week 2, after casting was 24° (95% CI: 14-33). The mean within-group differences for passive ankle dorsiflexion at completion of casting, Week 2 after casting and Week 8 after casting were 26° (95% CI: 20-31), 26° (95% CI: 18-33) and 24° (95% CI: 19-30), respectively. These improvements were sustained at Week 2 and Week 8 after casting.

[CONCLUSIONS] A programme for contracture management comprising serial casting, botulinum toxin, motor training and splinting can be useful in improving joint range.