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Neurological contracture and the therapeutic use of casting in the upper limb

Neurological contracture and the therapeutic use of casting in the upper limb

by Natasha Lannin

Presentation Description

In this presentation, Natasha will draw upon clinical examples and current research evidence to outline the rationale for treating contracture after central nervous system damage. In doing so, she will share her clinical experience of casting after brain injury and stroke, types of casts and precautions and contraindications. 


This webinar will support the learner to:

  • Understand the secondary complication of contracture which occurs following an upper motor neuron lesion.
  • Understand the clinical reasons for casting an adult with an upper limb impairment after an acquired brain injury (hypoxic, traumatic, vascular).
  • Understand the current research evidence base testing the effectiveness of casting.
  • List precautions when casting.
  • List the contraindications to casting.
  • Compare and contrast casting materials.
  • Compare and contrast types of casts, their indications and their potential benefits (and limitations).
  • Describe the clinical issues relating to casting an adult with an upper motor impairment.


  • Upper motor neuron lesions typically cause impairments of paralysis, muscle weakness and loss of sensation. These impairments limit the person’s ability to move and use their upper limb. A person with an upper motor neuron lesion with resultant paralysis (with or without spasticity) is at risk for developing a contracture.
  • Traditional treatments to prevent contracture include passive range of movement activities (“ranging”), positioning, splinting and casting. While stretching using positioning and splints has greater numbers of trials which suggest that therapists should not be routinely providing stretches or splints to address contracture, there are only a few casting trials and so the evidence is not yet as clear.
  • There is uncertainty about whether casting is an effective intervention to treat contracture in the long term, and if it is, we do not know yet how long casting will need to be provided for (either each cast in series, or the length of the cast series) nor how regularly it will need to be repeated.
  • Clinicians should remember the evidence supporting casting remains at an AMBER Level, and measure the effect of their own interventions on their client’s outcomes every time they apply a cast.

About Natasha Lannin

Natasha Lannin is a registered occupational therapist with over 25 years experience, including a PhD investigating the use of stretch to prevent contracture. Since 2019 she has held a Professorial position as the lead of the Brain Recovery and Rehabilitation Group at Monash University, where she continues research in partnership with Alfred Health (Melbourne).

Professional Development Points (CPD / PDP):

This webinar will account for 1 point(s) for the following associations:

  • Myothreapy Association
  • Osteopathy Australia

Certification: A completion certificate will be available to download upon successfully passing a 5 multiple answer questionnaire in your Members Area.

Webinar details

01 Dec, 2020
Recording (Online streaming and download)
60 mins
Myothreapy Association Osteopathy Australia
1 Point (MAA, OA)
Notes available to download
Via successful questionnaire submission