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When All Else Fails, Wrap It in Plaster

Young Arthritis Patients Finding Success in Old Technology

Tuesday, October 10, 2006

Arthritis usually conjures up pictures of the elderly with twisted and unbendable joints, but those complications are not isolated to older patients. Children, even as young as 5-years-old, can end up with wrists so inflamed and painful that they lose mobility, and sometimes even the most advanced medication, occupational therapy and high-tech splinting doesn’t work.

That’s when occupational therapist Dana Emery, O.T.R./L., pulls out low-tech plaster and casts the joint.

“This isn’t what casting was meant for, but it has been working well for patients who haven’t responded to other treatments,” said Emery, who works with Golisano Children’s Hospital at Strong’s pediatric rheumatology and immunology clinic through a partnership with the Upstate New York Chapter of the Arthritis Foundation. “It’s difficult for some of our young patients to keep splints on enough to make a difference in the range of motion; this way, they can’t even think about taking it off.”

Young patients with chronic diseases such as arthritis and lupus often experience intense pain in their wrists. To compensate they curl their hands in, particularly when asleep. Over time, that can shorten the tendons and ligaments on the inside of the wrist, making it difficult to extend their wrists past the straight (or neutral) position. Most often, patients will take medication and perform exercises to combat the problem. But that doesn’t always work. The next step is to splint the joint with a removable custom-made brace. That can also be unsuccessful, especially if patients take off the splints too often.

“That’s when we consider casting. It isn’t the best choice for all our patients, especially those who don’t live in the immediate area, but when all else fails, it’s wonderful to have the option,” Emery said.

Emery initially worked with chief occupational therapist Kathy Stoklosa, M.P.A., O.T.R./L., who, citing the medical literature, suggested casting the patients. Since early this summer casts have been used on two pediatric patients. Emery puts the casts on the first day aiming for five to 10 degrees past where the child can hold her wrist on her own. On the seventh day, the patient returns, the cast is removed and the range of motion is measured. A new cast is put on, again at 5 to 10 degrees past where the child can hold her wrist on her own. The final aim is for 70 degrees past the straightened joint, and so far, the casts have been successful.

 “We’re fortunate to have an innovative occupational therapist in our clinic, and we’re encouraged by the results of the casting treatment so far,” said David M. Siegel, M.D., M.P.H., chief of pediatric rheumatology and immunology at Golisano Children’s Hospital at Strong. “Without the support of the upstate chapter of the Arthritis Foundation, which provides a grant to pay for Dana’s time in the pediatric rheumatology clinic, patients wouldn’t have immediate and free access to the kind of care she provides.”

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