Serial casting for contractures in SMA: consensus derived guidelines for treatment
BackgroundIndividuals with Spinal Muscular Atrophy (SMA) often present with muscle contractures. Serial casting has been used in a variety of other peripheral nerve, muscle, and central nervous system disorders to improve knee and ankle range of motion limitations and functional performance in both...
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Frontiers Media S.A.
2025-04-01
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| author | Laurey Brown Katie Hoffman Chiara Corbo-Galli Carolyn Kelley Terri Carry Matt Civitello Giorgia Coratti Roberto DeSanctis Tina Duong Brigid Driscoll Jean Flickinger Allan M. Glanzman Jennifer Jones Elizabeth Maczek Dionne Moat Jacqueline Montes Robert Muni-Lofra Leslie Nelson Leslie Nelson Amy Pasternak Melanie Valle Kristin J. Krosschell Kristin J. Krosschell |
| author_facet | Laurey Brown Katie Hoffman Chiara Corbo-Galli Carolyn Kelley Terri Carry Matt Civitello Giorgia Coratti Roberto DeSanctis Tina Duong Brigid Driscoll Jean Flickinger Allan M. Glanzman Jennifer Jones Elizabeth Maczek Dionne Moat Jacqueline Montes Robert Muni-Lofra Leslie Nelson Leslie Nelson Amy Pasternak Melanie Valle Kristin J. Krosschell Kristin J. Krosschell |
| author_sort | Laurey Brown |
| collection | DOAJ |
| description | BackgroundIndividuals with Spinal Muscular Atrophy (SMA) often present with muscle contractures. Serial casting has been used in a variety of other peripheral nerve, muscle, and central nervous system disorders to improve knee and ankle range of motion limitations and functional performance in both ambulatory and non-ambulatory individuals.ObjectiveThe goal of this study was to reach a consensus about the parameters, considerations and general guidelines that should inform practice when serial casting to improve flexibility in individuals with SMA.MethodsThis international effort was conducted between August 2020 and May 2023. An expert panel of physical therapists was assembled with multiple panel meetings and a 2-round Delphi survey performed covering topics relevant to serial casting which included three domains: clinical appropriateness, program-based considerations and program adherence/feasibility. Consensus was reached for all items in the three topic areas using a validity index of >75%. Following completion of the Delphi survey, community insights from patients and caregivers were collected via semi-structured interview.ResultsThis study included the synthesis of meetings from the initial expert panel which produced a comprehensive survey for the different considerations when performing serial casting for an individual with SMA. The study also included the completion of a Delphi survey by 18 therapists in round 1 and 15 therapists in round 2 for a consensus on 296 items. Strong consensus was obtained in all three domains with 96.6% agreement for clinical appropriateness, 95.0% agreement for program-based considerations, and 96.9% for program adherence/feasibility. A guideline document was developed enumerating the specific items detailed in the survey. Community perspectives were utilized to support the results of the Delphi survey and to add insight into real-world experience.ConclusionThe serial casting guidelines developed upon collaborative discussions from the expert panel and from the Delphi survey consensus and semi-structured interviews, should be utilized when applying serial casts to patients with spinal muscular atrophy. Future endeavors should look to apply the guideline recommendations to determine casting efficacy for improving joint contracture and impact on function for those with SMA. |
| format | Article |
| id | doaj-art-42f0be21cd184dd3b4917cff2d066a57 |
| institution | DOAJ |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neurology |
| spelling | doaj-art-42f0be21cd184dd3b4917cff2d066a572025-08-20T02:40:31ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-04-011610.3389/fneur.2025.15024951502495Serial casting for contractures in SMA: consensus derived guidelines for treatmentLaurey Brown0Katie Hoffman1Chiara Corbo-Galli2Carolyn Kelley3Terri Carry4Matt Civitello5Giorgia Coratti6Roberto DeSanctis7Tina Duong8Brigid Driscoll9Jean Flickinger10Allan M. Glanzman11Jennifer Jones12Elizabeth Maczek13Dionne Moat14Jacqueline Montes15Robert Muni-Lofra16Leslie Nelson17Leslie Nelson18Amy Pasternak19Melanie Valle20Kristin J. Krosschell21Kristin J. Krosschell22Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United StatesAnn & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United StatesWeinberg College of Arts and Sciences, Northwestern University, Evanston, IL, United StatesChildren's Hospital of Colorado, Aurora, CO, United StatesChildren's Hospital of Colorado, Aurora, CO, United StatesSt. Jude Children's Research Hospital, Memphis, TN, United StatesAgostino Gemelli University Hospital, Rome, ItalyAgostino Gemelli University Hospital, Rome, ItalyDepartment of Neurology, Stanford University, Stanford, CA, United StatesAnn & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United StatesChildren's Hospital of Philadelphia, Philadelphia, PA, United StatesChildren's Hospital of Philadelphia, Philadelphia, PA, United StatesChildren's Hospital of Philadelphia, Philadelphia, PA, United StatesBoston Children's Hospital, Boston, MA, United StatesNewcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom0Columbia University Irving Medical Center, New York, NY, United StatesNewcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom1Dallas Children’s Medical Center, Dallas, TX, United States2Department of Physical Therapy, University of Texas – Southwestern, Dallas, TX, United StatesBoston Children's Hospital, Boston, MA, United States2Department of Physical Therapy, University of Texas – Southwestern, Dallas, TX, United StatesAnn & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States3Northwestern University Feinberg School of Medicine, Chicago, IL, United StatesBackgroundIndividuals with Spinal Muscular Atrophy (SMA) often present with muscle contractures. Serial casting has been used in a variety of other peripheral nerve, muscle, and central nervous system disorders to improve knee and ankle range of motion limitations and functional performance in both ambulatory and non-ambulatory individuals.ObjectiveThe goal of this study was to reach a consensus about the parameters, considerations and general guidelines that should inform practice when serial casting to improve flexibility in individuals with SMA.MethodsThis international effort was conducted between August 2020 and May 2023. An expert panel of physical therapists was assembled with multiple panel meetings and a 2-round Delphi survey performed covering topics relevant to serial casting which included three domains: clinical appropriateness, program-based considerations and program adherence/feasibility. Consensus was reached for all items in the three topic areas using a validity index of >75%. Following completion of the Delphi survey, community insights from patients and caregivers were collected via semi-structured interview.ResultsThis study included the synthesis of meetings from the initial expert panel which produced a comprehensive survey for the different considerations when performing serial casting for an individual with SMA. The study also included the completion of a Delphi survey by 18 therapists in round 1 and 15 therapists in round 2 for a consensus on 296 items. Strong consensus was obtained in all three domains with 96.6% agreement for clinical appropriateness, 95.0% agreement for program-based considerations, and 96.9% for program adherence/feasibility. A guideline document was developed enumerating the specific items detailed in the survey. Community perspectives were utilized to support the results of the Delphi survey and to add insight into real-world experience.ConclusionThe serial casting guidelines developed upon collaborative discussions from the expert panel and from the Delphi survey consensus and semi-structured interviews, should be utilized when applying serial casts to patients with spinal muscular atrophy. Future endeavors should look to apply the guideline recommendations to determine casting efficacy for improving joint contracture and impact on function for those with SMA.https://www.frontiersin.org/articles/10.3389/fneur.2025.1502495/fullDelphi techniqueconsensusspinal muscular atrophycontractureserial casting |
| spellingShingle | Laurey Brown Katie Hoffman Chiara Corbo-Galli Carolyn Kelley Terri Carry Matt Civitello Giorgia Coratti Roberto DeSanctis Tina Duong Brigid Driscoll Jean Flickinger Allan M. Glanzman Jennifer Jones Elizabeth Maczek Dionne Moat Jacqueline Montes Robert Muni-Lofra Leslie Nelson Leslie Nelson Amy Pasternak Melanie Valle Kristin J. Krosschell Kristin J. Krosschell Serial casting for contractures in SMA: consensus derived guidelines for treatment Frontiers in Neurology Delphi technique consensus spinal muscular atrophy contracture serial casting |
| title | Serial casting for contractures in SMA: consensus derived guidelines for treatment |
| title_full | Serial casting for contractures in SMA: consensus derived guidelines for treatment |
| title_fullStr | Serial casting for contractures in SMA: consensus derived guidelines for treatment |
| title_full_unstemmed | Serial casting for contractures in SMA: consensus derived guidelines for treatment |
| title_short | Serial casting for contractures in SMA: consensus derived guidelines for treatment |
| title_sort | serial casting for contractures in sma consensus derived guidelines for treatment |
| topic | Delphi technique consensus spinal muscular atrophy contracture serial casting |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1502495/full |
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