Casting Procedure Review and Questions

Key Points to Remember Prior to Casting: Suggest ideal clothing for casting: short sleeve shirt for casting process Ask parent what child enjoys to watch or request that they bring a pacifier or anything to help with distraction during casting Set out materials if possible (make sure casting is COMPLETELY removed from the assessment process and the assessor)

Key Points to Remember Assistance: Distraction in Place: Therapist to wrap Therapist to hold Caregiver holds child; possible additional person pulls thumb spica up at the shoulder as wrapping moves towards the upper arm Distraction in Place: Video, iPad, cell phone, pacifier, bottle, etc. Place on opposite side of the arm being casted

Casting Process Secure cut strip with strips of coflex (fingers, forearm, upper arm) Place Thumb spica –no wrinkles Place padding: Cut padding appropriately after observing the size of the child’s arm/hand Pad the following: 1. thumb 2. fingers/forearm (one piece) 3. elbow 4. ulnar styloid if forearm piece does not cover.

Cast Wrapping Therapist assisting: Do not squeeze casting material Make sure material is adequately covering (no shadows) Pulls on the end of the thumb spica to allow for proper finger and thumb placement; spread spica apart at fingertips Keeps the elbow at 90 degrees and slightly further for younger children to decrease slipping out of the cast Maintains neutral position of the arm/hand Helps to distract the child

Cast Wrapping Do not open cast wrapping material until you are ready to wrap Start with tip of thumb, move to fingers (1 inch) Focus rigidity (1 or 2 inch) –measure how much is needed, cut material, fold material in half and place on dorsal elbow surface (therapist assisting helps hold this in place) Wrap one layer to incorporate the hand with the rest of the cast…careful not too many layers. You will have to cut through what you wrap. Continue to move up the arm, overlaying each layer by half, checking to make sure coverage is correct and no wrinkles

After Wrapping Cast Make sure material is dry Start cutting at the hand/fingers Move along the cut strip all the way to the shoulder; sometimes at the elbow it is easier to move from the shoulder down to get the angle on the cut. Slip cut strip out without taking entire cast off Check fingers, thumb, and location of cast on upper part of arm prior to removing cast Remove cast and line ALL edges of the cast including tip of thumb (this can be done after the family leaves since the cast will not be placed on the child’s arm until the first day of treatment) Check for rough edges inside of cast (cover with edger)

Talking Points with Parents Regarding the Cast Discuss the importance of keeping the cast dry Provide a piece of stockinet and an umbrella bag to help keep the cast dry Suggest the families wait on a full bath until cast change and do a sponge or sink bath of sorts Discuss how to remove the cast in case of emergency Discuss importance of not pulling on the cast, especially for the younger ones Discuss importance of not putting items into the cast –cover the fingertips and thumb to avoid this if possible Determine the emergency point of contact and discuss with the family the protocol if something happens and they need to contact someone on the study.

Questions Regarding Casting For children, do we still need 3 separate pieces of padding? 2. Can you confirm which areas should have the edging? Does this include the thumb? Do you have any tips for cutting the cast off? Do you expect there to be redness right away when you take off the cast? Do you have any advice for how to keep the thumb less bulky?

Updates Use the form sent by email for the previous webinar to score fidelity Videos to score are on Dell computer for I-ACQUIRE Link to casting video from training: https://www.youtube.com/watch?v=6UKc4I_5PaE&feature=youtu.be Use the I-ACQUIRE@vtc.vt.edu e mail to contact our team with questions Contact IT to finalize setting up each computer Help Center at https://help.vtc.vt.edu and “start a conversation” Be prepared to have wifi access when doing so and be in a place where you most often connect to the internet