02517nas a2200361   4500000000100000008004100001260001500042653001000057653001100067653001100078653002200089653000900111653002200120653001600142653002300158653001200181653001900193653003100212653002000243653001600263653003900279100001900318700001600337700001700353700001500370700001900385700001900404245014800423300001100571490000700582520155200589022001402141       2008                            d  c586561379710aAdult10aFemale10aHumans10aFollow-Up Studies10aMale10aTreatment Outcome10aContracture10aPatient Compliance10aPosture10aBrain Injuries10aRange of Motion, Articular10aCasts, Surgical10aElbow Joint10aMotion Therapy, Continuous Passive1 aHerbert Robert1 aHarvey Lisa1 aMoseley Anne1 aLeung Joan1 aHassett Leanne1 aClare Jennifer00aSerial casting versus positioning for the treatment of elbow contractures in adults with traumatic brain injury: a randomized controlled trial.  a406-170 v223 a<p>
<b>OBJECTIVE: </b>To compare the effects of serial casting with positioning for 1 hour per day for the treatment of elbow flexion contracture in adults with traumatic brain injury.
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<b>DESIGN: </b>Pragmatic randomized controlled trial with concealed allocation and assessor blinding.
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<b>SETTING: </b>Four brain injury rehabilitation units.
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<b>SUBJECTS: </b>Twenty-six adults with elbow flexion contracture after traumatic brain injury participating in multidisciplinary inpatient rehabilitation.
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<b>INTERVENTIONS: </b>Subjects were randomized to receive either serial casting or positioning for two weeks. In the subsequent four weeks subjects could be positioned for up to 1 hour/day.
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<b>MAIN MEASURES: </b>Torque-controlled passive elbow extension was measured at baseline, post-intervention (two weeks), post-intervention plus one day, and at follow-up (four weeks post-intervention).
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<b>RESULTS: </b>All 26 subjects completed the study. Post-intervention, serial casting reduced contracture by an average of 22 degrees (95% confidence interval (CI) 13 to 31; P &lt;0.001) compared with the positioning group. One day later this effect had decreased to 11 degrees (95% CI 0 to 21 degrees; P= 0.052). The effect had almost completely disappeared at the four-week follow-up (mean 2 degrees, 95% CI -13 to 17; P= 0.782).
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<b>CONCLUSIONS: </b>Serial casting induces transient increases in range of motion. These effects are not maintained.
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  a0269-2155