Background Serial casting in children with acquired brain injury (ABI) is an effective physiotherapy treatment to improve ankle range of movement (ROM). There is less evidence for its effectiveness in the acute setting with emerging fluctuations in tone and patients are less medically stable. This abstract presents 4 case studies of children with acute ABI seen in the International and Private Population (IPP), whose lower limb ROM has been managed either with serial casting or in conjunction with botulinum toxin injections (BTX).

Aims To determine the effects of combined serial casting and BTX in the management of ankle contractures in preventing further surgical interventions following ABI in the short-term.

Method A retrospective case review of 4 children, aged 2 to 9 years, with varying pathologies of ABI seen from 2017-2019 at Great Ormond Street Hospital IPP. All 4 children presented with dystonic extensor posturing of the lower limbs with equinus plantaflexion position of the feet. 2 children had botulinum toxin followed by serial casting and 2 children had serial casting only. The number of casts ranged from 3 to 8 with a treatment duration of 2 - 6 weeks. ROM was used to monitor change.

Results All patients had an improvement in ankle dorsiflexion ROM. There were no adverse effects to serial casting. Surgical intervention was not required. Improvement in ROM enable patient participation in rehabilitation using supportive standing equipment. ROM was maintained using orthotics ankle foot orthosis.

Conclusion Serial casting combined with BTX was shown to be an effective treatment strategy for improving passive ROM in ABI. Serial casting should be considered as an adjunct therapy with this population.