Effect of Tone-Inhibiting Casts and Orthoses on Gait

Abstract

In the adult case presented, inhibitory casting proved successful in decreasing the positive support reaction. When casting was discontinued, the positive reaction returned. To provide a long-term solution for this problem, a polypropylene tone-inhibiting AFO was fabricated. It incorporated the same principles as the casts. The success achieved with casting was rapidly regained and then surpassed with the use of the tone-inhibiting AFO. Natural recovery might be cited by some as the cause for improvement in the patient presented. However, the loss of improvement during the interval between the removal of the inhibitory casts and the initiation of the use of the tone-inhibiting AFO demonstrates that the casting and the position provided by the casts had a positive effect on our patient. This notion is further supported by the fact that our patient still required use of the tone-inhibiting AFO as late as March 1980. We have no explanation for the rapid improvement following the cranioplasty. Suggestions for further research would include a similar study with a larger number of subjects and the use of cinematography and kinesiological EMG during walking with and without tone-inhibiting casts and orthoses to determine the effect of the devices on spastic muscle groups and gait patterns.

Serial plaster casting to correct equino-varus deformity of the ankle following acquired brain injury in adults

“…67 ± 6 9 In addition to applying tension to increase the extensibility of a shortened muscle, some authors have suggested that serial casting may have an inhibitory eOE ect on the casted limb, resulting in a reduction of muscle overactivity. 39,45,53,54,70 Gossman et al 71 have stated that the principal eOE ect of serial casting is to alter muscle length rather than to in¯uence neurological activity. However, this distinction may be inappropriate as there is some evidence to suggest that the two outcomes are inextricably connected.…”

The effect of serial casting on gait in children with cerebral palsy: preliminary results from a crossover trial

“…The casting period may be followed by a regime of splinting or casting for shorter periods during the day. [7,9]. Some authors have observed increases in ankle dorsiflexion secondary to inhibitive casting [11,[13][14][15] and gait improvements have also been noted.…”

“…Serial casting is used variably to inhibit the overactivity of the ankle plantarflexors [3][4][5][6][7][8][9][10][11][12][13][14][15] or to lengthen components of the musculo-tendinous unit [16][17][18][19][20][21][22][23][24]. Typically, inhibition is thought to be achieved by maintaining the foot and ankle in a neutral position for a period of over 2 weeks.…”

“…Bertoti [10] found stride length to increase in some of a group of 10 children with CP following 10 weeks of application of bivalved casts, for more than 4 h per day. Zachazewski et al [7] and Watt et al [11] normalisation of the foot contact pattern following casting for 3-4 weeks. Flett et al [14] showed an improvement in the gait pattern of 10 children following serial casting using two items of the Physicians' Rating Scale.…”

An Investigation of the Neurophysiologic Effect of Tone-Reducing AFOs on Reflex Excitability in Subjects with Spasticity Following Stroke while Standing

“…The majority of TRAFO literature consists of subjective studies that infer a reduction in spasticity based on observed changes in biomechanic and functional variables. 7,12,[20][21][22][23][24] Other criticisms include the lack of objective documentation of change in measured variables, lack of control groups and the potential bias of unblinded assessors. 25 The overall aim of TRAFO research is to evaluate effectiveness in reducing spasticity; however, no study to date has used a measurement tool sufficient to quantify this.…”