A new service at Basildon University Hospital is being trialled by physiotherapists to treat people with movement disorders.
One such disorder, dystonia, causes muscular spasms that result in awkward movements and posture and often pain for sufferers. The cause is not always known, but it may be a result of a stroke, Parkinson’s or a medical condition known as complex regional pain syndrome (CRPS).
Jayne Coulson, neurophysiotherapy team lead, and Justine Emmins, stroke physiotherapist, have been trained in a technique called serial casting, which involves applying a soft cast reinforced with a rigid fibreglass strip to the patient’s limb. Physiotherapists stretch the affected joint, apply the cast and leave it for three to four days to hold the stretch. When it is removed, flexibility has usually improved, and the process is repeated, each time with the joint being stretched a little more until the desired position is reached.
Justine explains: “A normal cast used for a fracture can be completely rigid, because it is holding the limb in a natural position. But because we are stretching patients’ joints from awkward positions, a rigid cast could hurt and damage their skin. So serial casts need to be soft, with a rigid fibreglass strip to hold the stretch.”
The first patient at Basildon Hospital to receive the treatment is Rachel Mowforth, 24. Her dystonia causes her considerable pain and discomfort, and she has limited range of movement in her right leg and her foot is badly twisted.
Rachel, who lives in Chadwell St Mary, was working as a one-to-one support worker in a special needs school when she was diagnosed by a neurologist with dystonia. Dr Simon Thomson, a specialist in pain medicine at Orsett Hospital, later identified that CRPS was the cause of her condition. Rachel is under the care of the pain management service at Orsett where a team, led by Dr Thomson, has treated her CRPS with a spinal cord stimulator. This has reduced her pain and enabled her to tolerate serial casting by physiotherapists at Basildon Hospital to treat her dystonia.
Rachel said: “I began getting knee pain when I was about 13 years old. After I left school the pain got worse and my right foot began to turn in. I have not seen my foot look straight for over five years now.”
Because of her condition, Rachel had to stop work before her daughter Charlotte, aged five years, was born, which was a huge blow to her. She had done voluntary work since she was 13 years old, inspired by a school friend who had spina bifida, and also learned British Sign Language.
She added: “The hardest part of what has happened to me is not that I have to use crutches and a wheelchair. Nor is it all the treatments and daily struggle I go through. It’s the fact that I had to give up a job that I truly loved.”
Jayne and Justine began serial casting on Rachel in May this year and have so far applied four serial casts. Between casts, the physiotherapists take measurements and photographs of her leg and foot. By July, after the fourth cast, Rachel’s foot was in a better position.
Jayne explains: “We put Rachel’s foot into a position outside its normal range that is bearable for her. To increase length of muscles they have to be held in a sustained stretch for more than six hours a day. We may do six or seven casts in total to try and help Rachel regain her range of movement and get her foot back into alignment.”
“We are hopeful that having the knowledge to apply this technique will help other patients with movement disorders who are in prolonged positions resulting in shortened muscle length, with the pain and difficulty that accompanies that.”
“Rachel has made significant progress, regaining full range of movement in her foot. Her leg is in a better position and she has more control over it, and she can put her foot flat on the floor. This will help in the next stage of her rehabilitation as she relearns to walk.”
The physiotherapists have provided Rachel with removable casts to maintain the improved position of her leg and foot. Two other patients, who have difficulty moving their elbows as a result of stroke, have been treated with removable fibreglass casts to help position their arms, reduce pain and allow recovery of some movement.
In spite of her pain, Rachel presents a very cheerful outlook, saying: “The way I try to look at it is that there are people worse off than me. I have had really good treatment
at Basildon and Orsett hospitals. Dr Thomson made me feel that someone was listening to me and understood exactly what I was saying. And Jayne and Justine are the best physios I have ever known.
“Words can’t describe how truly grateful I am to all the specialist staff I see and for the treatments I receive.”