Structured Abstract
Brain Injury Structured Abstract - BI #14
Casts may be more effective than traditional techniques in reversing contractures
CITATION: Hill, J. (1994). The effects of casting on upper extremity motor disorders after brain injury. American Journal of Occupational Therapy, 48(3), 219-224.
LEVEL OF EVIDENCE: IIB2b
This non-RCT 2 group treatment comparison design study, sample size below 20 per condition (n = 12) with moderate internal validity and moderate external validity provided a IIB level of evidence.
RESEARCH OBJECTIVE/QUESTION
To compare the effects of casting and traditional hypertonic treatment techniques on upper-extremity range of motion in persons with traumatic brain injury.
DESIGN
| |
RCT |
|
Single Case |
|
Case Control |
| |
Cohort |
X |
Before-After |
|
Cross-Sectional |
This study design is used to evaluate a group of individuals who are undergoing the same treatment. Information regarding a group of people is collected both before and after treatment. This is a common design that is generally paralleled with a single case/individual study. A before-after design usually involves more than one person whereas a single case study may involve only one individual.
Double crossover research design.
SAMPLING PROCEDURE
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Random |
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Consecutive |
| |
Controlled |
X |
Convenience |
Individuals were chosen strictly on a volunteer basis for completion of the study.
SAMPLE
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N = 15 |
M age = 28.5 |
Male = 13 |
Ethnicity = NR |
Female = 2 |
NR = Not reported
Participants were recruited from one rehabilitation center and randomly assigned to one of two groups. One group received casting followed by traditional therapy and the other group received traditional therapy followed by casting. Participants' age ranged from 9 - 44, with upper extremity contractures that interfered with function. The participants' traumatic brain injured diagnoses were not well defined. The eligibility criteria were wide. Ethnicity was not reported.
PARTICIPANT CHARACTERISTICS
Chronic Traumatic Brain Injured
MEDICAL DIAGNOSIS/CLINICAL DISORDER
Traumatic Brain Injury
OT TREATMENT DIAGNOSIS
Physical Substrates: Sensory Motor Substrates: Neuromuscular system: Range of motion, muscle tone
OUTCOMES
Upper-extremity joint range of motion
|
Measures |
Reliability |
Validity |
|
Goniometric measurement |
NR |
NR |
|
Observation of patients' performance of functional tasks |
NR |
NR |
|
Muscle length/muscle tone |
NR |
NR |
NR = Not Reported
Outcome - OT terminology
I. Performance Components
A. Sensorimotor Component
2. Neuromusculoskeletal
b. Range of motion
3. Motor
a. Gross Coordination
b. Fine Coordination/Dexterity
Outcome - ICIDH-2 terminology
Body Structure: Upper extremity range of motion & tone
INTERVENTION
Comparison Traditional treatment vs. Casting treatment
Description
- Traditional hypertonicity treatment
- Active ROM
- Splinting
- Neuropsychological
- Prolonged stretch
- Casting treatment
Who delivered
Occupational therapists
Setting
Rehabilitation center: Rehabilitation Institute of Chicago
Frequency
4-6 casts were applied during casting month
Duration
2-Month total
- Casting - Traditional therapy (1 month)
- Traditional therapy - Casting (1 month)
Follow-up
None
RESULTS
- Statistical Tests Used for Analysis: Two sample t tests and paired t tests
- Statistical Significance: Data analyzed between groups - And also pooled (crossover design)
- Summarize Key Results: Casting produced greater gain in ROM and muscle length (hypertonicity) than traditional therapy. No significant difference between treatments for the outcome measure of functional use of upper extremity between the two groups
CONCLUSIONS
Biases
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X |
Attention |
X |
Masking/blinding |
X |
Drop outs |
|
X |
Contamination |
|
Co-intervention |
|
Casting improved range of motion and decreased hypertonicity. The gains did not translate into functional use of the upper extremities.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice - Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Beatriz C. Abreu, PhD, OTR, FAOTA, and colleagues. For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.
