Reduction of Hypertonicity by Early Casting in a Comatose Head-Injured Individual

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Abstract
One of the common treatment problems encountered in comatose, head-injured patients is difficulty in maintaining normal joint range of motion (ROM) secondary to increased spasticity and prolonged posturing. Treatment techniques such as passive ROM, local and central inhibitory techniques, and splinting are often used in an effort to prevent adaptive shortening of soft tissue. In addition, various modifications of cylinder short leg plaster casts have been used to manage spasticity-induced contractures in children with cerebral palsy and patients who sustained cerebrovascular accidents, traumatic head injuries, or CNS infections.1–5 These types of casts have been called by various names in the literature: short leg casts,1,2 plaster drop-out casts,3 inhibitory casts,4 and serial casts.5 In the majority of documented uses, these casts have been applied during the subacute or chronic period of recovery, which is relatively late in the rehabilitation process.

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