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Serial casting
Dec 1, 2003
My son has mild CP which affects his arm and leg on one side only. He has worn a brace on his leg, but as he grows it is less effective. He has received botox injections in the past, but these too don't seem adequate to let the PT get enough stretching of his muscles and tendons.

Tomorrow we'll meet with an orthopedic surgeon to discuss serial casting, or possibly surgery.

Do any of you have experience with serial casting? Did you find it a good course of treatment?

Thanks.
Re: Serial casting
Dec 2, 2003
[QUOTE=Zagreus]My son has mild CP which affects his arm and leg on one side only. He has worn a brace on his leg, but as he grows it is less effective. He has received botox injections in the past, but these too don't seem adequate to let the PT get enough stretching of his muscles and tendons.

Tomorrow we'll meet with an orthopedic surgeon to discuss serial casting, or possibly surgery.

Do any of you have experience with serial casting? Did you find it a good course of treatment?

Thanks.[/QUOTE]


The orthopedic surgeon recommended tendon lengthening through surgery, though not immediately. He'll probably undergo the surgery about 4 - 6 months from now.

I'd appreciate hearing about your experiences with the surgery -- whether you found it significantly beneficial and how difficult or easy you found the experience to be. My boy's nine and is feeling some anxiety over this.
Re: Serial casting
Dec 5, 2003
My son is 11 & also has mild CP that effects the right side of his body. We were also recommended by the doctors for tendon-lengthening but decided against it.
The reason why we did NOT is because the CP effects the communication from the brain to the arms & legs, not the arms & legs itself. Why weaken a tendon (because that is what will happen if you have tendon lengthening) . We decided to try to STRENGTHEN the tendon as much as possible. Weights, exercise etc... At this point that doesnt seem to be making it any stronger, but he is using those parts of his body on a daily basis.
Dont get me wrong...i do second guess my decision & it still is not too late, but working on his self-esteem, social interaction with other kids his age, his education, & getting ready for the awkward teenage years seems top priority as opposed to "his limp will be hardly noticeable after surgery". It's a REALLY tough decision, but dont just read this post. Read the adults posts & think about his future as a growing adult. There are a lot you can learn from these people on this board, if you just read whats already been posted & make your decison out of love for your child.

Danny
Re: Serial casting
Dec 6, 2003
[QUOTE=Zagreus]The orthopedic surgeon recommended tendon lengthening through surgery, though not immediately. He'll probably undergo the surgery about 4 - 6 months from now.

I'd appreciate hearing about your experiences with the surgery -- whether you found it significantly beneficial and how difficult or easy you found the experience to be. My boy's nine and is feeling some anxiety over this.[/QUOTE]

I had that surgery when I was six years old (that was in Finland in the 70's, so your son's situation is a bit different). Well, I was really unmotivated, because I was all satisfied with my walking style (I couldn't put my right heel on the ground)... But afterwards, I've thought that the operation improved the quality of my life very much. My limp became much smaller and I've never needed other surgeries or braces or injections - I'm 32 now. But of course my ankle still needs stretching.

The recovery time, however, wasn't pleasant at all, because I didn't like the hospital ward I had to stay in. (But that was in the 70's, so probably the surgical technology has progressed and the recovery does not take so long.)

I've read that the tendon lengthening is most effective when done to a child (6-12 years old); when done to an adult, the recovery takes longer & the results are not so good.

Tendon lengthening is no miracle cure, and all operations aren't as successful as mine, but I would still recommend it, because the ankle becomes much more low-maintenance.
Re: Serial casting
Dec 6, 2003
[QUOTE=Dannycee]Dont get me wrong...i do second guess my decision & it still is not too late, but working on his self-esteem, social interaction with other kids his age, his education, & getting ready for the awkward teenage years seems top priority as opposed to "his limp will be hardly noticeable after surgery". It's a REALLY tough decision, but dont just read this post. Read the adults posts & think about his future as a growing adult. There are a lot you can learn from these people on this board, if you just read whats already been posted & make your decison out of love for your child.

Danny[/QUOTE]

Yep, it is a really tough decision. Being overactive with rehabilitation can damage a child's psyche. On the other hand, lessening the limp probably also helps self-esteem, social interaction etc. In my experience, tendon lengthening is troublesome in the short run, but eliminates many problems in the long run.
Re: Serial casting
Dec 7, 2003
Thank you for your replies.

Today the surgery is regarded as an outpatient procedure, though an overnight hospital stay is required.

I think lengthening the tendon helps because it enables the patient to gain better mobility and range of motion with the limb despite the neurological issues involved. My son's been involved with therapy since the age of two and we've only recently reached a stage in his growth where therapy, stretching, braces and botox on their own aren't adequate. My understanding, Dannycee, is that the surgical intervention provides a much greater window of opportunity for the therapies to succeed. I think I see it more as an integrated system -- it's not simply a matter of brain and nerves reaching the muscle, but also one of how effective those signals can be when they arrive. By lengtheing the cord, or by stretching, or by wearing a brace, we provide better opportunities for those signals to have the same effect as they do in a person not affected by cerebral palsy.

And, of course, we understand the importance of continued therapy and stretching. We're constantly stressing to my son that he'll do these things all his life. (At 9, he doesn't particularly like that message but it seems important to us that he come to understand it as part of his life -- just as brushing his teeth is).

Thank you all for your responses. I appreciate your taking the time to respond. Strawberry, I've shared your response with him. It's wonderful for him to hear from people who've undergone the procedures and who understand what he's going through in a way his parents can't.
Peace!
Re: Serial casting
Jan 4, 2004
[QUOTE=Zagreus]Thank you for your replies.

Today the surgery is regarded as an outpatient procedure, though an overnight hospital stay is required.

I think lengthening the tendon helps because it enables the patient to gain better mobility and range of motion with the limb despite the neurological issues involved. My son's been involved with therapy since the age of two and we've only recently reached a stage in his growth where therapy, stretching, braces and botox on their own aren't adequate. My understanding, Dannycee, is that the surgical intervention provides a much greater window of opportunity for the therapies to succeed. I think I see it more as an integrated system -- it's not simply a matter of brain and nerves reaching the muscle, but also one of how effective those signals can be when they arrive. By lengtheing the cord, or by stretching, or by wearing a brace, we provide better opportunities for those signals to have the same effect as they do in a person not affected by cerebral palsy.

And, of course, we understand the importance of continued therapy and stretching. We're constantly stressing to my son that he'll do these things all his life. (At 9, he doesn't particularly like that message but it seems important to us that he come to understand it as part of his life -- just as brushing his teeth is).

Thank you all for your responses. I appreciate your taking the time to respond. Strawberry, I've shared your response with him. It's wonderful for him to hear from people who've undergone the procedures and who understand what he's going through in a way his parents can't.
Peace![/QUOTE]

Hello Zagreus,

Tendon lengthening has been around for a long time. I had 6 of them between the ages of 5 to 11. I am 53 years old. I walk using 2 canes and I am married. I'm a retired Computer Tech. I think you made a good decision. The stretching is good, but it will only do so much. And one other thing you should be aware of is that "mild" CP is still CP and it can be a real bear. There's really nothing mild about having it.
Re: Serial casting
Jan 5, 2004
I had that surgery in 1985 at the age of nine at Johns Hopkins. Before the surgery I walked on the balls of both feet and afterward with a limp that is noticable. I certainly am glad that I had the surgery because the serial casting was not helpful. Myofascial massage therapy is also very helpful in undoing some of the compensations that have taken place because of the limp but after years of ignoring it, I have found that it really isn't such a bad thing to be forced to pay attention to one's body on a daily basis. If i don't stretch daily the limp because much more noticable and I experience a great deal of lower back pain as well as a tilted sacrum but i think even all of that would have been avoidable if I had incorporated a regimen of stretching and exercise at a much younger age.
Re: Serial casting
Jan 5, 2004
[QUOTE=amgfos]I had that surgery in 1985 at the age of nine at Johns Hopkins. Before the surgery I walked on the balls of both feet and afterward with a limp that is noticable. I certainly am glad that I had the surgery because the serial casting was not helpful. Myofascial massage therapy is also very helpful in undoing some of the compensations that have taken place because of the limp but after years of ignoring it, I have found that it really isn't such a bad thing to be forced to pay attention to one's body on a daily basis. If i don't stretch daily the limp because much more noticable and I experience a great deal of lower back pain as well as a tilted sacrum but i think even all of that would have been avoidable if I had incorporated a regimen of stretching and exercise at a much younger age.[/QUOTE]


It's very hard to expect a regular regimen of stretching of a nine year-old. I have to admit we occasionally get lax, but we do try to keep at it. We let him have a break over the holidays and now it's time to get back to the routine.

Thank you all for your replies. They are encouraging and I'll share your encouragement with my son.
Re: Serial casting
Jan 6, 2004
I didn't want to do all those stretches either when I was nine, or ten, or eleven. I don't think it was until puberty hit that I really started to pay attention to my body. Sometimes I took my anger at being "different" out on my mother by refusing to do the stretches, the eye exercises (add a lazy eye to those issues) and no matter how much anyone told me to I refused to use my right hand. In the end it was my desire to learn to play the piano that got me to use it and even though I can type, write right handed and play the piano now at 28, the difference in the size of my hands is such that people comment that it doesn't look like they belong to the same person. If my parents had bought a piano as a kid I might have been motivated to do what they asked but I was really resistant to doing the exercises just because I had to. It didn't help that my father had the urnealisitic expecation that surgery meant I wouldn't need to stretch any more and that it would make me perfectly normal.
Re: Serial casting
Jan 6, 2004
[QUOTE=amgfos]I didn't want to do all those stretches either when I was nine, or ten, or eleven. I don't think it was until puberty hit that I really started to pay attention to my body. Sometimes I took my anger at being "different" out on my mother by refusing to do the stretches, the eye exercises (add a lazy eye to those issues) and no matter how much anyone told me to I refused to use my right hand. In the end it was my desire to learn to play the piano that got me to use it and even though I can type, write right handed and play the piano now at 28, the difference in the size of my hands is such that people comment that it doesn't look like they belong to the same person. If my parents had bought a piano as a kid I might have been motivated to do what they asked but I was really resistant to doing the exercises just because I had to. It didn't help that my father had the unrealisitic expecation that surgery meant I wouldn't need to stretch any more and that it would make me perfectly normal.[/QUOTE]

Amgfos,
I endured so many "experimental" surgeries and so much physical thearpy between the ages of 5 and 17 that I could just scream, even now! While it is important to stretch and exercise the joints and muscles, it's especially important to do this while your bones and muscles are still growing. After they stop, I'm sorry to say, that's about it for mobility and posture improvement. Even though I was born with CP, I have never been "spastic", or tense. I just plain couldn't move or work some muscles in my legs, and to you parents out there, 47 years later, I still can't move those very same muscles. Even with all the stretching and thearpy I endured as a child... My doctors did move muscles that I could control into places that I had no control, so that I could walk. I did get rid of leg braces because of these muscle relocations or "transplants", as some called them.
Re: Serial casting
Jan 6, 2004
[QUOTE=Zagreus]My son has mild CP which affects his arm and leg on one side only. He has worn a brace on his leg, but as he grows it is less effective. He has received botox injections in the past, but these too don't seem adequate to let the PT get enough stretching of his muscles and tendons.

Tomorrow we'll meet with an orthopedic surgeon to discuss serial casting, or possibly surgery.

Do any of you have experience with serial casting? Did you find it a good course of treatment?

Thanks.[/QUOTE]

Serial Casting a "new torture" for the Millennium... Sounds good for a growing child, but what are the long-term benefits? What shape is this child going to be in at say, 20 or 30 years old? Botox is a bacteria. What lasting effects will this have on a child?
Re: Serial casting
Jan 7, 2004
[QUOTE=musicmaker650]Serial Casting a "new torture" for the Millennium... Sounds good for a growing child, but what are the long-term benefits? What shape is this child going to be in at say, 20 or 30 years old? Botox is a bacteria. What lasting effects will this have on a child?[/QUOTE]

You truly misunderstand the procedure. No bacteria are injected into the body. I've seen wonderful benefits from this procedure for my child. It is not torture and your calling it that is truly unfair. This treatment has enabled my child to have much greater benefits from his therapy, enabled him to increase his level of physical activity, and given him new enthusiasm for his therapy. Serial casting has done the same for other children, although that is not the long term therapy we will be pursuing with my child.
The long term benefits include greater physical mobility, less damage to growth plates in the bones caused by muscle spasticity, greater range of motion, greater confidence and less fear.
Before one casts aspersions on a therapeutic technique, one needs to be better informed about the procedures. Statements such as yours may discourage others from investigating therapies which may benefit them.
Re: Serial casting
Jan 7, 2004
[QUOTE=Zagreus]You truly misunderstand the procedure. No bacteria are injected into the body. I've seen wonderful benefits from this procedure for my child. It is not torture and your calling it that is truly unfair. This treatment has enabled my child to have much greater benefits from his therapy, enabled him to increase his level of physical activity, and given him new enthusiasm for his therapy. Serial casting has done the same for other children, although that is not the long term therapy we will be pursuing with my child.
The long term benefits include greater physical mobility, less damage to growth plates in the bones caused by muscle spasticity, greater range of motion, greater confidence and less fear.
Before one casts aspersions on a therapeutic technique, one needs to be better informed about the procedures. Statements such as yours may discourage others from investigating therapies which may benefit them.[/QUOTE]

Less damage to the growth plates is so critical. I have many friends with CP (notice I didn't use the word "mild" before CP) and their growth has been "stunted" by having CP and damage to their growth plates. I am over 6 feet tall, and I have stiff (not spastic) knees. Can you imagine what a ***** this is? My brother is over 6' 4", so my growth might have been stunted... I don't smoke.

As far as torture is concerned. When I was your son's age, we had standing tables, where the child was placed in full length leg braces. These braces were locked at the knee and the child was placed upright in this "table" for hours at a time. THIS WAS TORTURE! Trust me! Being forced to sleep with locked braces was torture too. Serial Casting sounds like the same type of thing to me. Even though it may have lasting benefits... It's still a form of slow TORTURE!

Ask your children when they're a little older. For that matter just having CP is a form of torture. You really can't understand this, if you haven't lived it. I know you parents always try to do what's best for your children. I'm just trying to bring a little dreaded reality to this forum. I am actually pleased with some of the new treatments revealed here. The fact that the medical knowledge is allowing even more premature babies to survive is scary. I was 2 months premature in 1950. All children regardless of their physical or mental conditions, need to be loved and accepted :)
Re: Serial casting
Jan 7, 2004
My son is loved and accepted -- more than you could possibly know.
The procedures you underwent sound very painful -- I'm truly sorry for that. But there are also critical windows of opportunity for some procedures. I believe today's procedures are far more humane than what you describe.
I wish you all the best.
Re: Serial casting
Jan 7, 2004
[QUOTE=Zagreus]My son is loved and accepted -- more than you could possibly know.
The procedures you underwent sound very painful -- I'm truly sorry for that. But there are also critical windows of opportunity for some procedures. I believe today's procedures are far more humane than what you describe.
I wish you all the best.[/QUOTE]

Thearpy is so very important, to minimize the disabilities effects and minimize pain. You're so right about the "critical window"...To be loved and accepted is even more important, in the larger scheme of things.





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