Efficacy for Maintenance of Elbow Range of Motion of Two Types of Orthotic Devices: A Case Series

Audrey Yasukawa*, Bryan S. Malas, Deborah J. Gaebler-Spira

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


This pilot study was designed to examine the efficacy of maintaining elbow range of motion using two different programs, Ultraflex and bivalve cast, following botulinum toxin type A (BTX) injection and serial casting. The subjects included three children, 7 years of age, with primary diagnoses of cerebral palsy who demonstrated severe-to-moderate spasticity interfering with passive or active movements at both elbows. Before the BTX injection, a baseline evaluation was performed that included the Modified Ashworth Scale, passive range of motion, and caregiver questionnaire. Evaluation occurred pre-BTX, and at 2, 6, and 8 months after BTX. One week after BTX injection, each child underwent an initial serial casting program for both elbows. As the child plateaued with passive range of motion, a bivalve fiberglass long arm cast was applied to one of the involved limbs and a definitive orthotic device, Ultraflex, was applied to the other limb to maintain the range. The use of the Ultraflex showed better maintenance of elbow range of motion when compared with the bivalve cast. Overall, parents preferred the Ultraflex and were pleased with the long-term results. After the serial casting program, the findings suggested that the increase in range of motion was temporary. The results of this study suggest that the Ultraflex offered easier adjustments to the length-tension change at the elbow and ability to maintain range of motion when compared with a bivalve cast, although further research is needed.

Original languageEnglish (US)
Pages (from-to)72-77
Number of pages6
JournalJournal of Prosthetics and Orthotics
Issue number2
StatePublished - Apr 2003


  • Bivalve cast
  • Cerebral palsy
  • Elbow orthosis
  • Muscle spasticity

ASJC Scopus subject areas

  • Biomedical Engineering
  • Orthopedics and Sports Medicine
  • Rehabilitation

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