AIM To assess the efficacy of intermittent serial casting in conjunction with occupational therapy and botulinum neurotoxin A (BoNT-A) in children with cerebral palsy (CP) presenting spastic wrist flexion deformity. METHOD This was a controlled, prospective study in which 34 children (19 females, 15 males; mean [SD] 11y [4y 6mo]) were randomly allocated to casting or control groups in a ratio of 2:1. Both groups were subjected to BoNT-A treatment and occupational therapy. The casting group additionally received a series of progressive casts intermittently for three consecutive weekends. Outcome measures consisted of passive range of motion (PROM) as assessed by goniometer, muscle tone by Modified Ashworth scale (MAS), and spasticity by Tardieu Scale. Assessments were done at baseline, week 4, and week 12. RESULTS Baseline characteristics of casting and control groups were comparable. PROM, MAS, and Tardieu angle of catch (XV3) of the casting and control groups significantly improved after treatment (p<0.001 for all). Nevertheless the mean change from baseline MAS at week 12, mean changes from baseline PROM, Tardieu XV3, and the spasticity grade (Y) at week 4 and week 12 of the casting group showed statistical superiority over those of the control group (p<0.05 for all). INTERPRETATION Children with CP presenting spastic wrist flexion deformity might gain additional benefits from supplementary intermittent serial casting as well as BoNT-A injections and occupational therapy. Serial casting could be considered as a complementary treatment to BoNT-A and occupational therapy in children with clinically significant PROM limitations.

中文翻译：

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痉挛型脑瘫患儿腕关节屈曲畸形间歇性连续施法：随机对照试验

目的 评估间歇性连续铸造联合作业疗法和肉毒杆菌神经毒素 A（BoNT-A）治疗表现为痉挛性腕关节屈曲畸形的脑瘫（CP）儿童的疗效。方法 这是一项受控的前瞻性研究，其中 34 名儿童（19 名女性，15 名男性；平均 [SD] 11 岁 [4 岁 6 个月]）以 2:1 的比例随机分配到铸造组或对照组。两组均接受 BoNT-A 治疗和职业治疗。选角组还在连续三个周末间歇性地接受了一系列渐进式选角。结果测量包括由测角仪评估的被动运动范围 (PROM)、由改良 Ashworth 量表 (MAS) 评估的肌肉张力和由 Tardieu 量表评估的痉挛。在基线、第 4 周和第 12 周进行评估。结果铸造组和对照组的基线特征具有可比性。铸造组和对照组的 PROM、MAS 和 Tardieu 捕获角 (XV3) 在治疗后显着改善（所有 p<0.001）。尽管如此，铸造组第 12 周与基线 MAS 的平均变化、与基线 PROM、Tardieu XV3 的平均变化以及第 4 周和第 12 周的痉挛等级 (Y) 显示出优于对照组的统计学优势（p<0.05对所有人）。解释 出现痉挛性腕关节屈曲畸形的 CP 儿童可能会从补充性间歇性连续铸造以及 BoNT-A 注射和职业治疗中获得额外的好处。对于具有临床显着 PROM 限制的儿童，连续铸造可被视为 BoNT-A 和职业治疗的补充治疗。