Serial casting

The serial casting program was started in 1992 by physical therapist Mary Weck, orthotist Moira Tobin Wickes, and Issac Tolliver, orthotic technician. The program has helped more than 400 children gain independence with standing and walking over the past 14 years. The program is run jointly by the physical therapy and orthotic departments.

Serial casting is a process in which a joint or joints that are limited in range of motion are immobilized with a well-padded plaster and fiberglass cast. The casts are applied and removed on a weekly basis. During the process, the affected joint or joints are gradually set in a more correct alignment until the desired joint range of motion is achieved.

During the casting process the child and family are treated by the physical therapist for alignment, gait and correction of center of mass. At the completion of serial casting orthotic intervention is initiated with solid ankle AFOs for daytime use and solid night AFOs in dorsiflexion. (AFOs are ankle-foot orthoses that brace the lower limb — the lower leg, ankle, and foot — and maintain the alignment that was gained during the serial casting process.) The serial casting program continues after the actual casting process with physical therapy and orthotic intervention until the child is done growing.

Involvement in the serial casting program is initiated with a referral from a physician. Each child is evaluated by a physical therapist and orthotist to discuss the program and determine the child's plan of care. The actual casting process can take anywhere from 6 to 16 weeks. The child is seen weekly for a 2 to 3 hour appointment to have new casts applied and receive their home exercise program.