Upper Limb Casting for Children with Hypertonia

This study aims provide a clearer picture of how Novita services align with the latest available evidence while highlighting possible inconsistencies in the provision of Upper Limb (UL) casting as an intervention across services sites and client groups. Identification of knowledge gaps and any training requirements would ensure UL casting intervention is provided in a consistent manner to clients across the organisation.


Research aim

The project was directed by the following research questions:

  • What is the clinical reasoning used by OTs at Novita to decide when to use UL casting and what are the documented protocols for this?
  • What are the documented outcomes of UL casting and how were these measured?
  • What, if any, post-casting follow up was documented as being provided to clients?
  • Does UL casting practice used at Novita over the past five years match with current best practice evidence?



Children with cerebral palsy or an acquired brain injury frequently present with hypertonia of one or both upper limbs. Hypertonia is a condition marked by an abnormal increase in muscle tone which can impact upon a child’s function and participation in daily activities. Upper Limb (UL) casting is one intervention currently used by OTs at Novita. The clinical aims for casting may include reducing hypertonia, increase range of movement (ROM), reduce and/or prevent contractures, increase ease of night time positioning, increase ease of hygiene management, reduce pain and improve function.

A wide variety of factors are reported to influence clinical reasoning and decision making by OTs. These can be related to:

  • The client: e.g. age, individual diversity of UL posture and function, severity of spasticity, presence of contractures and pain.
  • The family: e.g. family preferences and capacity to support the intervention, child’s ability to tolerate casting, daily routines, environments the child needs to access.
  • The clinician: e.g. limited high level evidence, limited experience and opportunity to become familiar and confident in using casting as an intervention.



It is anticipated that the coda files of 21 clients will be reviewed. Inclusions: Children aged 3-17 years, MACS Level II-V who are current or previous Novita clients and who have received UL casting over the past 5 years. Some children may have had more than one episode of casting. Exclusions: Past Novita clients whose coda files are no longer readily accessible.



Review client coda files (hard copy and electronic) and G drive to collect retrospective data on UL casting interventions provided to Novita clients over the past 5 years Data collection tool – spreadsheet will be piloted with 6 clients and then reviewed/updated as required. The updated data collection tool will be used to gather the remaining 15 clients’ data.


Potential outcomes and implications?

For children and families: Clients will be offered information on the full range of possible interventions, including casting. Families will be able to access UL casting interventions that are of high quality and evidence based.

For professionals: Novita OTs will have up to date information on best practice relevant to UL casting and clinical reasoning tools to guide their decision making..

For administrators/policy makers: Novita will be seen as a leader in SA in the provision of high quality evidence based services to clients with hypertonia.


Research team

Chief investigator

Anna Klemm, Senior Occupational Therapist, Physical Rehabilitation Program, Novita Children’s Services

Associate Investigators

Sarah Andruchowycz, Senior Occupational Therapist, Physical Rehabilitation Program, Novita Children’s Services

Dr Toan Nguyen, Senior Rehabilitation Engineer, Knowledge & Innovation, Novita Children’s Services

Contact person

Anna Klemm
(08) 8172 9200
[email protected]